BC Naturopaths imminent to be granted prescribing power/minor surgery/lab/imagi

[Dr. Slick]

Wow… I was googling and found this forum. So I am new here, but I read pretty negative comments. I am an FCOEP, ER physician in USA. I was a ND before I went to a DO school. I’d say my ND school was almost as good as my DO school. Less pt contacts for sure, but comparable courses were almost at par. I aced my COMPLEX because of solid education in ND school.

 

Well, it’s just an opinion from a lowly DO. Maybe I missed out a lot. I need to go to a MD school now!

 

-I once met a Canadian GP who politely asked me how I, an osteopath, can be an ER doc.

[NLengr]

ND schools are different in Canada and the US from what I have read. The US ones being stronger and more focused on actual medicine/science, and less on asian medicine, homeopathy, and other pseudoscience. If you look at the calendar for the 2 Canadian ND schools (neither of which are associated with a legitimate institution of higher learning, aka a university), you'll see that pseudoscience makes up a huge chunk of the program.

 

Also, if you read the way that the govt/ND association is trying to get this to pass, it stinks to high heavens of back door politics, lies and sleeze. That's generating quite a bit of the anger. If the ND's and the govt. had actually reached out to the public and the physicians and tried to engage a legitimate dialogue about their concerns, instead of trying to ram legislation through as fast and as quietly as possible, with little public consultation, then people wouldn't be as pissed off and worried.

 

The line from the ND's seems to be: "Well, because of recent legislation, some of our compounds are now prescription. Therefore, we need access to all pharmaceuticals and laboratory tests."

 

As for DO's, we don't really have those schools in Canada, so the curiosity was probably genuine. Hell we have very few DO's in practice (so few in fact that I'd venture to say many Canadian physicians haven't heard of a DO), and the few we do have are mostly in family practice.

[Daemos]

Even the schools in the USA are not associated with any ligitimate institution of higher learning (by your standards)

 

If you look at the links here:

http://www.naturopathic.org/viewbulletin.php?id=29

http://www.cand.ca/index.php?40

http://www.cnme.org/links.html

 

You will find there are only 7 ND schools that are accredited, those include the two in Canada. Only then does that allow you to write the NPLEX which is the licensing exam that all Naturopathic Doctors need to take.

 

So it's not possible to put down the Canadian institutions and say they are not good, because obviously they are good enough to be accredited schools by the Naturopathic Medical education associations.

 

Although I would still say these schools still do not offer as much education, there is much misinformation, Arizona's school has rotations in actual hospitals, and outside of these institutions there are many schools that offer "ND" degrees, but that does not mean they are accredited and they can train "Naturopathic Medical Doctors" as they like to call them. From people I know that go to these schools "Naturopath" is associated with those non accredited schools, and "Naturopathic Medical Doctor" is associated with the ones that are accredited.

 

I still believe if they want prescription rights they should be tested and only those who pass should be allowed to write up prescriptions.

[chrismac]

Here's the course listings for the CCNM

 

http://www.ccnm.edu/?q=prospective_students/course_listings

 

It's short on science/real medicine, but has lots of crap in it like Asian medicine and homeopathy.

 

Unfortunately, quickly looking over a course listing is not the same as actually taking the courses. If you check out the UofT med curriculum... which I'm sure many of us are familiar with - you'll see that it looks much more sparce that the naturopathic link provided above (it actually looks like we don't learn much there at all!) http://www.facmed.utoronto.ca/programs/md/curriculum/schedule.htm.

 

The point is that you can't judge a book by it's cover. In my years of experience, I have had several opportunities to work with naturopathic doctors. You would be amazed by the perspective they often have to offer. Yes -- it is different from ours -- but it very often makes sense, and actually compliments what it is we're doing. In the end, we all have to keep in mind that we are there to serve the patient. Many of our patients present with vague symptoms... fatigue, stress, etc. Assuming there isn't an underlying condition, we can't always help them. We don't have a medicine for stress. We don't have a medicine for fatigue (unless you count coffee!). For these patients, I often refer to a naturopath and I have seen wonderful results when the two types of medicine are combined. I have a friend who is an oncologist in Toronto who swears that he knows the minute a patient walks in the door if they're seeing a naturopath. "They just look healthier" is what he always says.

 

The bottom line is, put your egos aside... and open your mind to the possibility of working in cooperation with other health care providers such as naturopathic doctors. In this day and age, patients are WANTING natural approaches to health care in addition to the services we provide. At the very least, we as MDs should be recognizing that naturopaths are the most qualified out there in terms of natural medicine. And as responsible caregivers, if a patient is going to seek care from a natural health care provider, we should support them in this decision and refer them to someone who at the very least has the qualifications and education that a naturopath has. I really urge all of you to look beyond your bubble and explore the other health professionals that are out there. I know that for myself, doing so has really allowed me to form better connections with my patients and provide better care. And in the end... that's what it's all about.

[Laika]

We don't have a medicine for stress. We don't have a medicine for fatigue (unless you count coffee!).

 

If you count caffeine for fatigue, I think it's only fair you count alcohol for stress!

[Dr. Slick]

Taking about pseudoscience, medicine isn’t exactly science either. My fav ER Tx for myalgia (e.g. acute low back pain due to muscle spam) is valium… Another one, what do you do for a pt who’s coughing crazy, but allergic to codeine? Nebulized lidocaine! These are off-label use, and there is no “real science” as in EBM. According to research, less than 10% of pacemaker surgeries met EBM criteria. Most of us confuse our “scientific reasoning/guesswork” with hardcore science. But I could care less, because they work and help patients.

 

As for homeopathy, RCT evidence behind it is inconclusive at best, but I know that it works in clinical practice. Homeopathy works for a very good scientific reason - counseling and placebo-effect. Homeopathy intake is quite lengthy (a few hours) and involves much talking on patient’s emotions, feelings, and life experiences. Homeopathy intake could be seen as a variation of certain conventional psychotherapy techniques. Most common form of homeopathy intake is very similar to the empty-chair technique of Gestalt therapy. Gestalt therapy is “scientifically-proven” to be effective in treating a wide range of "psychosomatic" disorders including migraine, ulcerative colitis and spastic neck and back. It's a super good way to treat crazy patients - hypochondriacs. They are still our patients and "sick", but we really have nothing for them.

 

We also know that placebo effect is responsible for 30% of therapeutic effect. So the patient who goes to see a ND and given a homeopathy Tx is unknowingly getting psychotherapy plus placebo at the end. Two proven Tx strategies synergistically used in clinical setting must work. I can tell you that many NDs that I trained with know this already. Of course, they don’t tell their patients…otherwise, won’t work as well. You guys all know that we have sham surgeries and Rx placebos too (e.g. deactived implanted medical device). So why dis homeopathy if it works well, economical, and safe?

 

I think Asian medicine NLengr mentioned is acupuncture. Acupuncture has substantial EBM behind it… much more evidence than… say… lidocaine in managing acute cardiac arrhythmia.

 

I am in Arizona and here NDs write full scrips, everything. They are GPs. I think giving NDs in BC Rx pads is going to have much benefit. Here in Arizona, there are much inter-professional exchanges, referral, and consultation happening. And NDs are much more involved with mainsteam medicine, much evidence-based in their approach. And patients are generally much more satisfied with the care they receive under this model. More importantly, patients assume an active role taking care of their health. There is a big difference between “just telling patients to eat well and exercise” and “being able to give specific tools and targeted advices”. MDs and DOs don’t have that kind of expertise, but NDs do. And when they scribe, they are very conservative and though (i.e. take time to check things over). In general, NDs have been providing good primary care in my town. At my ER, I haven't had a single case of incompetent care or Rx screw-up from NDs.

 

As for their training, they have pretty solid education. I’d say most of those who “pass” their licensing exams (NPLEX) would have no problem passing COMPLEX or USMLE. It’s not like NPLEX is very different from COMPLEX or USMLE. When I was a ND student, I used USMLE prep material to prepare for NPLEX. For COMPLEX, I shared my old notes from ND school and NPLEX practice exams with my DO buddies. NPLEX is as easy as or as difficult as COMPLEX or USMLE. Let’s not get too condescending.

[leviathan]

Taking about pseudoscience, medicine isn’t exactly science either. My fav ER Tx for myalgia (e.g. acute low back pain due to muscle spam) is valium… Another one, what do you do for a pt who’s coughing crazy, but allergic to codeine? Nebulized lidocaine! These are off-label use, and there is no “real science” as in EBM. According to research, less than 10% of pacemaker surgeries met EBM criteria. Most of us confuse our “scientific reasoning/guesswork” with hardcore science. But I could care less, because they work and help patients.

 

As for homeopathy, RCT evidence behind it is inconclusive at best, but I know that it works in clinical practice. Homeopathy works for a very good scientific reason - counseling and placebo-effect. Homeopathy intake is quite lengthy (a few hours) and involves much talking on patient’s emotions, feelings, and life experiences. Homeopathy intake could be seen as a variation of certain conventional psychotherapy techniques. Most common form of homeopathy intake is very similar to the empty-chair technique of Gestalt therapy. Gestalt therapy is “scientifically-proven” to be effective in treating a wide range of "psychosomatic" disorders including migraine, ulcerative colitis and spastic neck and back. It's a super good way to treat crazy patients - hypochondriacs. They are still our patients and "sick", but we really have nothing for them.

 

We also know that placebo effect is responsible for 30% of therapeutic effect. So the patient who goes to see a ND and given a homeopathy Tx is unknowingly getting psychotherapy plus placebo at the end. Two proven Tx strategies synergistically used in clinical setting must work. I can tell you that many NDs that I trained with know this already. Of course, they don’t tell their patients…otherwise, won’t work as well. You guys all know that we have sham surgeries and Rx placebos too (e.g. deactived implanted medical device). So why dis homeopathy if it works well, economical, and safe?

 

I think Asian medicine NLengr mentioned is acupuncture. Acupuncture has substantial EBM behind it… much more evidence than… say… lidocaine in managing acute cardiac arrhythmia.

 

I am in Arizona and here NDs write full scrips, everything. They are GPs. I think giving NDs in BC Rx pads is going to have much benefit. Here in Arizona, there are much inter-professional exchanges, referral, and consultation happening. And NDs are much more involved with mainsteam medicine, much evidence-based in their approach. And patients are generally much more satisfied with the care they receive under this model. More importantly, patients assume an active role taking care of their health. There is a big difference between “just telling patients to eat well and exercise” and “being able to give specific tools and targeted advices”. MDs and DOs don’t have that kind of expertise, but NDs do. And when they scribe, they are very conservative and though (i.e. take time to check things over). In general, NDs have been providing good primary care in my town. At my ER, I haven't had a single case of incompetent care or Rx screw-up from NDs.

 

As for their training, they have pretty solid education. I’d say most of those who “pass” their licensing exams (NPLEX) would have no problem passing COMPLEX or USMLE. It’s not like NPLEX is very different from COMPLEX or USMLE. When I was a ND student, I used USMLE prep material to prepare for NPLEX. For COMPLEX, I shared my old notes from ND school and NPLEX practice exams with my DO buddies. NPLEX is as easy as or as difficult as COMPLEX or USMLE. Let’s not get too condescending.

Given that 90% of the ND curriculum is homeopathic medicine, chinese medicine, etc...I highly doubt they would be able to pass the USMLE with their half course in pharm, path, anatomy, etc. There's an ND in my medical school, and he certainly is not breezing through.

[wtkchen]

Homeopathy works for a very good scientific reason - counseling and placebo-effect.

 

Does placebo effect save lives?

Does it decrease the hospitalization mortality / infant mortality / stroke risk?

 

The fact that Canada's healthcare system is publicly funded requires the government to spend on healthcare modalities that are "evidence-based" and can have a measureable impact on the health indexes, rather than spending billions of tax dollars on the sugar pills.

 

If I have an acute medical condition and require to go to ER, I would like to be seen by a physician with a MD, FRCPC/CCFP(EM), than a ND. I need evidence-based care that will improve my chance of survival/recovery statistically, rather than just NDs giving me placebos. Even though NDs may sit down and spend more time talking to me and give me a more 'holistic' healing experience than ER docs, I'd rather have a proven therapy to reverse my unstable angina / rapid afib. In the ER, I can always talk to a social worker / psych nurse / psychiatrist on-call if I need someone to counsel me about my holistic suffering.

 

Sure, naturopathy has its uses (eg. certain chronic diseases / lifestyle modifications, etc), but naturopathy should be limited to the niche of complementary/alternative medicine, and not trying to lobby the government or advertise to the public to become the primary manager of medical conditions.

 

Is this placebo effect how naturopaths justify pushing chelation therapy / vitamin/supplement injections / colon hydrotherapy / expensive natural food products onto the gullible/unsuspecting public? The fact that naturopaths 'prescribe' and dispense (ie sell with direct profit) these products and services makes it a pretty convenient way to make lots of money, don't you think. And it's all based on consumer's "confidence" in believing in whatever naturopaths say.

 

What if these "placebo devices" actually do harm? As in renal failure in chelation therapy and colon perforation/chronic diarrhea with colon hydrotherapy / vitamin toxicity. How do naturopaths justify that?

 

I suppose when NDs get privilege to order labs/imaging, they can simply order Abdo Xrays/US/CT/MRI whenever their patient comes in with abdo pain after colon cleansing; make a standing order of complete toxicology analysis 3x/week to track the progress of the heavy metal poisoning; have a standing order of weekly vitamin C levels to monitor the progress of the supplement. Perhaps ESR & CRP for everyone with arthritis, and testosterone level for everyone with weak sexual performance?

 

Just killate me now.

[NLengr]

Unfortunately, quickly looking over a course listing is not the same as actually taking the courses. If you check out the UofT med curriculum... which I'm sure many of us are familiar with - you'll see that it looks much more sparce that the naturopathic link provided above (it actually looks like we don't learn much there at all!) http://www.facmed.utoronto.ca/programs/md/curriculum/schedule.htm.

 

There is a vast difference between UofT having a sparse course listing due to the way the courses are structured (and therefore listed) and a ND school teaching courses in pseudoscience (ex. homeopathy).

 

As for acupuncture, I wouldn't go as far to say there is substantial evidence behind it. Substantial evidence behind a medication would be things like thrombolytics improving outcomes in MI. To be more accurate about acupuncture, it has limited evidence of effectiveness in a limited amount of conditions. At the best, more studies are required, it is far from a proven therapy.

[leviathan]

Substantial evidence behind a medication would be things like thrombolytics improving outcomes in MI.

Thrombolytics aren't actually all that substantial. Yes, they work, but not in everyone and with a lot of bad complications in others. Primary PCI on the other hand has a bit more potential.

[leviathan]

Just killate me now.

Hahaha... nice!

[Dr. Slick]

Given that 90% of the ND curriculum is homeopathic medicine, chinese medicine:

People just blatantly make false statements. Calculated from the curriculum on CCNM website, is 66% conventional vs 33% non-conventional courses such as botanical meds, clinical nutrition, homeopathy, asian meds, etc. Go check it out and do the math.

 

Does placebo effect save lives? Does it decrease the hospitalization mortality / infant mortality / stroke risk?

Yes, it does. 30% clinical efficacy is what that means. Know your definition.

Oftentimes placebo does the job better by avoiding unnecessary meds and delaying invasive interventions. For example, if you can help certain mental illnesses with counseling and placebo, psychotropic drugs are not necessary. I am an emergentologist and see on daily basis the more meds patient is on, the worse outcome is when invasive measures are needed. You simply don’t have much option when your patient is on 20 meds. If they are on 20 placebos, it’s a different story.

 

The fact that Canada's healthcare system is publicly funded requires the government to spend on healthcare modalities that are "evidence-based" and can have a measureable impact on the health indexes, rather than spending billions of tax dollars on the sugar pills.

 

Correction: not billions of tax dollars, thousands of dollars at most. Homeopathic pills are dirt cheap, a few cents per pill and you only take it once in a while

 

People need to think about risk/benefit ratio and benefit/cost ratio, not to mention quality of life while being intervened. New surgeries and meds look fine and dandy on paper, but generally risk/benefit ratio is marginally better than existing interventions and benefit/cost ratio is horrendous. US healthcare is in a financial ****hole, partly because every mom and pop in town is popping CABG and stent like vitamin pills. This is not financially sustainable at current rate. Speaking of evidence, there’s tons of multi-center, hospital trial papers comparing risk/benefit and benefit/cost ratios of preventive/non-pharmacosurgical measures and invasive drug therapy/surgical interventions. So to better serve your publicly funded system, what are you doing to your practice to implement these evidence? Those evidence has demonstrated a measureable impact on the health indexes, rather than spending billions of tax dollarson drugs and surgeries. Giving aspirin, statins and telling them lose weight are not going to cut it.

 

Is this placebo effect how naturopaths justify pushing chelation therapy / vitamin/supplement injections / colon hydrotherapy / expensive natural food products onto the gullible/unsuspecting public?

 

Chelation not being part of ND core curriculum, I’d like to know how many NDs in your town actually perform chelation. Did you just Google and found out some NDs doing that? If that’s the case, I can give websites of MDs doing chelation in Canada. If you want to make a few weirdos represent the entire group of people. How about a few moron MDs giving out low dose chemo drugs to normal people for weight loss to represent entire MD profession?

 

For many years, allopaths have criticized osteopathic manipulation – that it’s dangerous and offer no benefit to the patient; that DOs should drop it and stick to MD curriculum. Now guess what? Research shows that osteopathic manipulation is as efficacious as certain allopathic interventions. While I don't advocate chelation, absence of evidence is not always evidence of absence.

 

Some vitamin/supplement/natural foods have therapeutic effects that meet EBM criteria. Not as many as pharmaceutical, but it’s getting there. Don’t think that everything you learn from med school is EBM. EBM do not include clinical experience and pathophysiologic rationale as sufficient grounds for clinical decision-making. Many of what we do do not meet EBM crietria.

 

The fact that naturopaths 'prescribe' and dispense (ie sell with direct profit) these products and services makes it a pretty convenient way to make lots of money, don't you think. And it's all based on consumer's "confidence" in believing in whatever naturopaths say.

 

There’s nothing wrong for being smart businessman. Anyway, other good reasons are “quality control”, “ease of access”, and “enhanced service”. Products that NDs prescribe can be dangerous if used without discretion. So the supplements manufacturers do not make those products available directly to public. And most pharmacies would rather sell ten dollar a bottle supplement of their choice directly to the public for more profit. Not all supplements being equal and pharmacies unwilling to carry certain brands and formulations that NDs request, NDs have no option, but to have their own dispensary in their office. Not only it costs a lot of money to do that, but also it’s more of a management headache than being a money maker. Is it for profit? Sure thing, but also it’s the same reasons why meds spas and some dermatologists sell high potency cosmetics in their office. There are plenty of MDs doing that in your town. So call up your college and report this unethical practice. Let's clean up our plate first, before we request others to do so.

 

I suppose when NDs get privilege to order labs/imaging, they can simply order Abdo Xrays/US/CT/MRI whenever their patient comes in with abdo pain after colon cleansing; make a standing order of complete toxicology analysis 3x/week to track the progress of the heavy metal poisoning; have a standing order of weekly vitamin C levels to monitor the progress of the supplement. Perhaps ESR & CRP for everyone with arthritis, and testosterone level for everyone with weak sexual performance?

 

NDs in US already have access to labs and diagnostic imaging. They have their own lab, X-ray, US in their schools. CT and MRI they send their patients to radiologist office. NDs here have full access to all diagnostic amendities. BC NDs have been ordering labs through out-of-state labs. And simply put, with those "privilege already available", they are not doing what you said. So don't kill yourself yet.

 

What if these "placebo devices" actually do harm? As in renal failure in chelation therapy and colon perforation/chronic diarrhea with colon hydrotherapy. How do naturopaths justify that?

As an ER doc, I’d be the first one to know if events as such happen in my town. Still I haven’t seen one. It’s the same old argument that’s been used for chiropractic and osteopathic manipulation – ‘oh what if those manipulations cause aneurysm or cauda-equaina syndrome…’. Whatever DCs and NDs have been doing, they did it safely enough so that ER docs like me don’t see their patients on our beds. Where is your “evidence” that they’ve been killing patients?

On the other hand, I’ve seen a few perforated bowel from liposuction performed by MD and renal failure from meds scribed by MD for cosmetic purpose. How do you justify that? Shouldn’t we take away medical licenses of those performing elective or vanity procedures?

 

One’s absence of knowledge does not equate to one’s knowledge of absence. MDs tend to contract a special viral infection that causes the narsitic personality disorder (a DSM-IV condition of a pervasive pattern of grandiosity and need for admiration). I suggest reading of wide variety of peer-reviewed journals, introspection of allopathic profession, and less gossiping to treat this condition.

[A-Stark]

No time to reply to all of this, but...

 

Given that 90% of the ND curriculum is homeopathic medicine, chinese medicine:

People just blatantly make false statements. Calculated from the curriculum on CCNM website, is 66% conventional vs 33% non-conventional courses such as botanical meds, clinical nutrition, homeopathy, asian meds, etc. Go check it out and do the math.

 

So? We have no idea what kind of material gets covered in those courses. What kind of students get admitted to this program? It's also patently obvious that their clinical training falls *well short* of a Canadian med school.

 

Does placebo effect save lives? Does it decrease the hospitalization mortality / infant mortality / stroke risk?

Yes, it does. 30% clinical efficacy is what that means. Know your definition.

Oftentimes placebo does the job better by avoiding unnecessary meds and delaying invasive interventions. For example, if you can help certain mental illnesses with counseling and placebo, psychotropic drugs are not necessary. I am an emergentologist and see on daily basis the more meds patient is on, the worse outcome is when invasive measures are needed. You simply don’t have much option when your patient is on 20 meds. If they are on 20 placebos, it’s a different story.

 

The "placebo" is not doing anything, but that's not to say that a more psychosocial approach to treatment is not warranted in general. Pray tell, how do placebos reduce infant mortality? In any case, it goes without saying that a patient on 20 meds is going to be in substantially worse shape at the outset than one on 20 placebos. This is, quite simply, the prototypical comparison of apples and oranges. Or what are you trying to say?

 

I'm not sure whether you have an axe to grind or not, but DO's are essentially unheard of in Canada. Do naturopaths not promote the use of "detoxification" and the like?

[A-Stark]

And concerning the so-called accredited schools, please see the "Education of Naturopaths" here: http://www.naturowatch.org/general/beyerstein.html

 

Although the Committee found the syllabuses of many [naturopathic] colleges were reasonable in their coverage of basic biomedical sciences on paper, the actual instruction bore little relationship to the [publicized] course. . . . [Lectures were] exposition of the terminology of the medical sciences, at a level of dictionary definitions, without benefit of depth or the understanding of mechanisms or the broader significance of the concepts [12:74].

 

This part is particularly interesting:

 

The province of British Columbia has partially insured naturopathic services since 1965. We wondered how this had come about. In our interviews with naturopaths and their associations, we repeatedly asked for scientific justification for their procedures. While producing nothing of substance, many practitioners argued that the fact that the partial coverage of their services by the British Columbia Medical Services Plan must mean that the Ministry of Health finds them scientifically acceptable. Deciding to pursue this, we contacted the Ministry in Victoria in March 1997. After outlining our request for information, we were referred to an official who identified himself but preferred, understandably, to speak off-the-record. Asked why coverage was extended to some naturopathic treatments, this senior administrator said that (a) the ruling was based on political rather than scientific grounds; ( the Ministry was unaware of any scientific research supporting naturopathy; and © coverage of the services had been extended in response to consumer demand and intensive lobbying by naturopaths. He also hinted that cost-saving had also been a factor, because naturopaths are compensated at a lower rate than MDs and siphon off a portion of those with vague, self-defined ailments or chronic conditions who would otherwise congest the medical services sector at a much higher cost per patient.

 

Arguably, the siphoning off of individuals with vague non-specific "chronic" conditions (aka the "worried well" or else people with some sort of psychiatric pathology) is not an intrinsic bad thing from a cost-savings perspective. It seems ethically problematic that naturopaths would attempt to take advantage of such situations for their own financial benefit.

[leviathan]

Given that 90% of the ND curriculum is homeopathic medicine, chinese medicine:

People just blatantly make false statements. Calculated from the curriculum on CCNM website, is 66% conventional vs 33% non-conventional courses such as botanical meds, clinical nutrition, homeopathy, asian meds, etc. Go check it out and do the math.

I know that given the current rate at which material is crammed down our throats in medical school, replacing that with even 33% of fluff material is leaving out the prerequisite knowledge to practice allopathic medicine. If you want to be an ND and give your patient snake oil therapies, that's a different story. If you want the right to practice in the realm of allopathic medicine, then you should go to medical school.

 

Yes, it does. 30% clinical efficacy is what that means. Know your definition.

Oftentimes placebo does the job better by avoiding unnecessary meds and delaying invasive interventions.

That would be the exception to the rule. What are these 'unnecessary meds' that are being given which are leading to a higher mortality?

 

For example, if you can help certain mental illnesses with counseling and placebo, psychotropic drugs are not necessary. I am an emergentologist and see on daily basis the more meds patient is on, the worse outcome is when invasive measures are needed. You simply don’t have much option when your patient is on 20 meds. If they are on 20 placebos, it’s a different story.

While I agree with you about psychotropic medications and their evident abuse in medicine, I disagree with the rest. A patient on 20 meds is by nature of their condition probably very sick to begin with. The 20 meds they are on are not the reason they had the worse outcome. Do you know the difference between correlation and causation? Correlation seems to be what naturopaths learn to back up their methods, rather than randomized clinical trials.

 

Giving aspirin, statins and telling them lose weight are not going to cut it.

So what naturopath interventions will cut it? Does giving them colon cleansing therapy reduce the incidence of acute coronary syndrome? In all seriousness, since you said NDs don't practice this in large numbers (in spite of all the ads in my yellow pages), I'd like to hear some of the evidence-based treatments that NDs perform to lower coronary disease. Maybe you can change my mind about them?

 

For many years, allopaths have criticized osteopathic manipulation – that it’s dangerous and offer no benefit to the patient; that DOs should drop it and stick to MD curriculum. Now guess what? Research shows that osteopathic manipulation is as efficacious as certain allopathic interventions. While I don't advocate chelation, absence of evidence is not always evidence of absence.

Great, I am glad to hear that accupuncture and OMM and other therapies are beginning to be found to be effective. I am all for them, and I hope allopaths begin to incorporate them in their practice. And that is the difference, the difference that naturopaths are out there practicing hundreds of things that have no proven benefit, most of them at a waste of money to the provider, and sometimes at the expense of them receiving proper treatment from a physician.

 

As an ER doc, I’d be the first one to know if events as such happen in my town. Still I haven’t seen one. It’s the same old argument that’s been used for chiropractic and osteopathic manipulation – ‘oh what if those manipulations cause aneurysm or cauda-equaina syndrome…’. Whatever DCs and NDs have been doing, they did it safely enough so that ER docs like me don’t see their patients on our beds. Where is your “evidence” that they’ve been killing patients?

Not going to look now, but there is definite proof that chiropracters cause many cases of vertebral artery dissection every year in Canada. That's just an example.

 

On the other hand, I’ve seen a few perforated bowel from liposuction performed by MD and renal failure from meds scribed by MD for cosmetic purpose. How do you justify that? Shouldn’t we take away medical licenses of those performing elective or vanity procedures?

Not if the patient is aware of the risks involved and consents to it, and most importantly, that procedure will have some benefit to the patient (even if it is a cosmetic benefit). That is the difference is that these greasy naturopaths performing colon cleansing and 'detox' treatments are practicing absolute quack medicine and are conning people out of their money. Those types of procedures are of NO benefit.

 

One’s absence of knowledge does not equate to one’s knowledge of absence.

Unfortunately this is the prevalent and only defense of naturopaths. If you want to prescribe unproven treatments to patients, I don't mind, as long as there is no better alternative in the allopathic field. In many cases there is, and patients are conned out of their money, and perhaps in some cases, their lives.

[wtkchen]

And concerning the so-called accredited schools, please see the "Education of Naturopaths" here: http://www.naturowatch.org/general/beyerstein.html

 

 

Thanks for the link.

 

The BCMA Society of General Practice also provided the following link of "Naturopathy: A Critical Appraisal"

http://www.medscape.com/viewarticle/465994_2

 

Below are some excerpts:

 

Naturopathic Treatments

 

Naturopathic treatments include colonic irrigation (enemas) and fasting for "detoxification," hydrotherapy (wrapping part or all of the body in wet towels), homeopathy, acupuncture, chiropractic manipulation, aromatherapy, arduous dietary regimens, intravenous vitamin C, hydrogen peroxide and ozone, whole enzyme pills, herbs, desiccated animal organs, and other "natural remedies." Naturopaths sell these preparations to their clients at a profit, a practice that is both formally approved and joined by the AANP.

 

How does this translate into the practice of naturopathic medicine? The following recommendations and practices are representative:

 

- The repudiation of standard treatments of streptococcal pharyngitis,[17] acute otitis media,[18] and other childhood infectious diseases, offering instead homeopathy, hydrotherapy, and "natural antibiotics" (eg, herbs such as Goldenseal).

 

- Affiliation with the antivaccination movement.[10]

 

- The repudiation of standard treatments of asthma, offering instead, for example, a hydrogen peroxide bath to "bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry" or "gems and minerals ... worn as jewelry, or placed around the home in special places."[19] This quotation is from "Articles written by Naturopathic Physicians for the general public" (on the AANP Web site). The author is listed as a "senior editor of the Journal of Naturopathic Medicine, the official publication of the AANP."

 

- Recommendations, by the Bastyr University AIDS Research Center, for treatment of HIV-positive patients with St. John's wort and garlic (both of which have been shown to reduce blood levels of highly active antiretroviral therapy agents), "acupuncture detoxification auricular program," whole-body hyperthermia, "adrenal glandular," homeopathy, "cranioelectrical stimulation," digestive enzymes, colloidal silver, and nearly 100 other dubious methods.[20,21]

 

- Warnings against proven medical and surgical treatments for hypertension, hyperlipidemia, and atherosclerosis, while instead recommending herbs and EDTA chelation.[22]

 

- The insertion of endonasal balloons, followed by their inflation in the nasopharynx, to "release tensions stored in the connective tissue and return the body to its original design," thus curing learning disorders and a host of other problems.[23,24]

 

- Treatment of the acute stroke patient for at least 20 minutes with an "ice-cold compress ... over the carotid arteries under the jaw bone on the neck" (which "may even abort the stroke") and subtle energy medicine.[25] The author of these recommendations is listed as a "senior editor of the Journal of Naturopathic Medicine, the official publication of the American Association of Naturopathic Physicians."

 

- The early detection of multiple sclerosis by "pulse" and "tongue" diagnosis, such as to effect a cure by hydrotherapy, homeopathy, acupuncture, diet, and other methods.[26] The author of these claims is Chief Medical Officer of the Southwest College of Naturopathic Medicine.

 

- The prevention and cure of breast cancer by an assortment of nonstandard tests and "supplements."[27] The author of these claims "has lectured regularly at the Canadian College of Naturopathic Medicine on breast health and stress management."

 

- The treatment of cancer of the prostate with "electrical current in the form of positive galvanism, applied transrectally."[28] This recommendation is from "Articles written by Naturopathic Physicians for the general public" (on the AANP Web site). The author is Chief Medical Officer of the Southwest College of Naturopathic Medicine.

 

- Ubiquitous "toxin" claims, including antifluoridation statements, warnings against most proven pharmaceuticals, and the assertion that "25% of Americans suffer from heavy metal toxicity."[29]

 

- "Natural childbirth care in an out-of-hospital setting" using a "naturopathic approach [that] strengthens healthy body functions so that complications associated with pregnancy may be prevented."[7]

 

- Nearly 100 nonstandard uses for vitamin C recommended by the Textbook of Natural Medicine.[4]

 

- The promotion and sale of "dietary supplements" for virtually all complaints.

 

Like the NCCAM, WebMD also admonishes readers to seek only licensed naturopaths: "without licensing standards, individuals with little or no formal education may proclaim themselves naturopathic physicians without medical school education or board testing."[48] The clear message is that such licensing implies competence. There is, however, no evidence that "educated" naturopaths -- the most prominent of whom provided the clinical examples for this article -- are more competent than others.[9] If anything, "traditional naturopaths" (ie, those who did not attend the "approved" schools) may be less of a threat to public health because they do not pretend to be primary care physicians.

 

Graduates of campus-based, 4-year naturopathic programs who have passed a standardized examination may demonstrate consistency from one practitioner to the next. But that says nothing about the validity of what they do -- which can be determined only by reference to the facts of nature and by rigorous testing of biologically plausible claims. At least one leading CAM researcher has acknowledged this fact:

 

Those who believe that regulation is a substitute for evidence will find that even the most meticulous regulation of nonsense must still result in nonsense.[53]

[A-Stark]

The more time I spent on http://www.quackwatch.org tonight, the more I was convinced that Dr Slick is either a troll or has a clear axe to grind against so-called "allopathic" medicine. I would, in fact, discourage use of that term; there is medical practice based on evidence and scientific reasoning (even if it boils down to treatments which show efficacy without clear mechanisms) and there is quackery which is based on "traditions", unverified (or disproven) claims, and the like.

 

(Oh, and, osteopathic manipulation is quackery, at least insofar as "craniosacral" therapy is concerned. How does one manipulate fused skull bones?)

[leviathan]

How does one manipulate fused skull bones?)

Through use of The Force. You can learn this training at my new School of Jediopathic Medicine, which is offered through a series of audiotape books and hands-on training with lightsabres. Also includes 3 credit course on Reiki. Will be covered under MSP by the end of the year.

[BlackJack]

This is clearly a money issue, since it does not do anything to improve patient care. In fact, it likely endangers patients.

 

Knowing what one doesn't know is extremely important in medicine. These NDs do not seem to portray this quality.

[Daemos]

Ok seriously, what are the admissions requirments for an ND?

 

Sure GPA is not everything, but it is somthing...

 

Back in Osler's era med education was modernized and lives saved by making the entry requirments for an MD program somthing respectable. If you want to practice medicine here is a idea... Get a doctorate in MEDICINE.

 

This is not politically correct but I don't care because it is truth. I spent 11 years straight in university. The fact an ND who has not spent a day in university is somehow the same as 11 years of study is a joke. It is like me saying I can fly a fighter jet after learning how to fly a kite. What a slap in the face to BC's real medical doctors.

 

A doctorate doesn't make you a physician, or does not having one not make you one

 

North American professional culture it seems, is obsessed with giving a doctorate degree to any professional program (Law, medicine, chiropractic, dentistry, there is even now a nursing doctorate), somehow I guess it makes the degree more worth while.

 

You have to also remember there are MANY countries in the world that allow students to go into medical school for 6 years right out of high school, and even the graduate entry programs, they get bachlors degrees. Either MBBS, MBchb or some variation. These degrees allow them to practice medicine as Medical Doctors, or MDs, and the MD degree is reserved for even higher learning (on the level of a PhD for medicine).

 

MBBS. MBChB, these "bachlors" degrees are considered equivalent to the MD degree earned in North America.

[cheeseshredder]

Ok seriously, what are the admissions requirments for an ND?

 

Sure GPA is not everything, but it is somthing...

 

Back in Osler's era med education was modernized and lives saved by making the entry requirments for an MD program somthing respectable. If you want to practice medicine here is a idea... Get a doctorate in MEDICINE.

 

This is not politically correct but I don't care because it is truth. I spent 11 years straight in university. The fact an ND who has not spent a day in university is somehow the same as 11 years of study is a joke. It is like me saying I can fly a fighter jet after learning how to fly a kite. What a slap in the face to BC's real medical doctors.

 

While I do not support NDs here, I have to point out that the ND programs do require 4 years of undergrad, with their program being 4 years too. What is debated is how much they actually learn in those 4 years of ND training.

 

I was browsing through their website and found that out, since previously I had been misled that it was some sort of "one year certificate" program due to some the egos of certain people here.

[NLengr]

North American professional culture it seems, is obsessed with giving a doctorate degree to any professional program (Law, medicine, chiropractic, dentistry, there is even now a nursing doctorate), somehow I guess it makes the degree more worth while.

 

I'd just like to point out that an LLB (bachelor of laws), not a doctorate, is the std. law degree for lawyers in practice. A doctorate in laws is really only held by professors.

 

Engineers and Chartered accountants, the other 2 of the big 5 "classic" professions (medicine, law, engineering, chartered accountants and dentistry) also don't have an obsession about doctorates.

 

The health professions are the ones that have the "doctor" obsession.

[BlackJack]

I'd just like to point out that an LLB (bachelor of laws), not a doctorate, is the std. law degree for lawyers in practice. A doctorate in laws is really only held by professors.

 

Engineers and Chartered accountants, the other 2 of the big 5 "classic" professions (medicine, law, engineering, chartered accountants and dentistry) also don't have an obsession about doctorates.

 

The health professions are the ones that have the "doctor" obsession.

 

 

UofT law school has just recently changed their law degree to a JD(Juris Doctor). Apparently, this will make them more competitive for the American job market, where JDs are the standard degree offered. Inevitably, all other Canadian law schools will follow suit.

[Daemos]

yep the JD is the degree now being handed over at the undergraduate level for law.

 

If you walked into a hospital and required immediate attention, would you not want to be treated by someone who has a MBBS, or MBChB? would you need to see someone with a MD degree?

 

And I will correct my self, it is the health professions that have an obsession with the "Doctorate" in North America.

[wtkchen]

yep the JD is the degree now being handed over at the undergraduate level for law.

 

If you walked into a hospital and required immediate attention, would you not want to be treated by someone who has a MBBS, or MBChB? would you need to see someone with a MD degree?

 

And I will correct my self, it is the health professions that have an obsession with the "Doctorate" in North America.

 

As may have been misinterpreted from my previous post, let me rephrase my comment:

 

"If I walked into a hospital and required immediate attention, I would rather be looked after by a physician (be it MD, MBBS, or MBChB) who is licensed to practice by the local College of Physicians and Surgeons." FYI, licensing requries: completion of medical school, residency, LMCC I & II, certification/royal college exams, 3 letters of reference from physicians, criminal background checks.

 

Also, in most (if not all?) Canadian universities, completion of medical school only gives an "undergraduate degree", granting you the title MD; residency training = postgraduate training (after exams, gives you the additional title: CCFP/FRCPC); further training beyond core residency = fellowship.