Naturopathic Medicine

[Mithrandir]

What exactly is it? Has anyone here ever been to see a naturopathic doctor or had any interest in becoming one?

I have a friend from university who was always a bit of a hippie but very intelligent who just told me she was going to be a doctor. I was all excited and asked her what med school she got into and she said that she's going to the Canadian College of Naturopathic Medicine in Toronto.

I always had this view of Naturopathic medicine as something anyone could really do, more of a pseudoscience scam- like crystal healing, or tea-leaf reading and stuff like that. I looked up the website though and its a four year degree and you need an undergrad with pretty extensive prereqs to get into it. I didn't think being a Naturopathic Doctor was something that would take 8 years of schooling. Which got me questioning:  is Naturopathy more of a profession than I thought and I just have a stereotyped idea of it in my head? Or is it just a horrible money scam? 

I'm actually super curious. Does anyone have any experience with it at all?

 

[Jaybird]

Morons, hacks, and quacks. I can get 8 years of schooling in a ton of different things, doesn't mean any of it is worth anything.

[Birdy]

A former naturopath who left her career upon taking a hard look at what she was actually doing did a fantastic breakdown of naturopathic clinical education at Science-Based Medicine.

 

https://www.sciencebasedmedicine.org/nd-confession-part-1-clinical-training-inside-and-out/

 

Thing is, a huge amount of their education is in things like homeopathy - the system devised a couple hundred years ago that is based on the belief that water has a magical memory. They get more education in energy therapies (people using supposed mystical forces to channel healing into the patient) than in pharmacology. To me, it doesn't matter how much education you get in nonsense, it's still nonsense.

[Arztin]

BS, that's what it is.

[SunAndMoon]

You guys are so close minded and really need to open your Chakras. 

[Arztin]

You guys are so close minded and really need to open your Chakras. 

I'm open to whatever works. However, I don't approve naturopathy, which incorporates homeopathy, which doesn't work unfortunately. It is against many of the most basic and fundamental notions of pharmacology such as minimum effective concentration. I also don't approve that people get fooled into believing that these stuff will cure them, which it obviously won't.

http://www.oand.org/naturopathic-medicine/about-nds/

 

dilute, dilute and dilute........

 

Now, for spiritual comfort, that's another thing, that's another debate.

[SunAndMoon]

My message was absolutely not serious  

[Arztin]

My message was absolutely not serious

whoa sorry! my bad! LOL

[JohnGrisham]

As someone who is strongly rooted in science, I have tried a few things like energy healing and body work...just to see what its like and be open minded. Now dont get me wrong, I am the first to bash things or correct them if they are wrong... But I didnt find it all that bad. Now I dont believe necessarily in the chakras and quantum blah blah, but as a "patient", the end result of relaxation and therapeutic understanding was quite real for me. I like to think of most of them as just as they are called: complimentary and alternative, not replacement. I recieved the quality attention and care I was craving, at a price but received nonetheless. I can see why people get into those things. Having someone focus their time into "healing" you, from a psychological sense is quite amazing. I suposse its somewhat akin to a placebo affect being therapeutic as well. Regardless it did no harm and stayed within its bounds, and I appreciated it thusly so.

 

As for NDs. For the most part its meh and they need to stay tightly in their scope of practice. I have a friend whom is finishing up 3rd year in Vancouver and they them self did a BSc at UBC and they have shown me how little they really do learn and says they definitely would not be comfortable stepping outside her bounds and cringes when colleagues think they have equal training to MDs(holy run on sentence batman). Luckily for her she knew all that going in, and is focusing her practice on the affluent Vancouver westside crowd and is fine with it.

[JohnGrisham]

I think artzin touched upon the term I was probably going for in my first paragraph: spiritual comfort.

[xkittens]

1. Real medicine can't cure or tangibly treat many illnesses, especially the chronic ones. 

2. MD's do not give a **** about you

3. Naturopaths are really passionate about what they do, they also seem to care more and spend more than 3 minutes not answering your questions with you. 

 

Anddd you end up with people swearing by their naturopaths. I don't blame em. 

[Birdy]

There are problems in medicine. That doesn't mean the solution is magic.

 

I think it's Ben Goldacre (he of 'Bad Pharma' fame) who made an analogy I'm rather fond of. Arguing that non-reality-based methods should be supported because there are problems in medicine is akin to supporting the use of flying carpets because of the problems in aviation.

[Fleming]

As someone who is strongly rooted in science, I have tried a few things like energy healing and body work...just to see what its like and be open minded. Now dont get me wrong, I am the first to bash things or correct them if they are wrong... But I didnt find it all that bad. Now I dont believe necessarily in the chakras and quantum blah blah, but as a "patient", the end result of relaxation and therapeutic understanding was quite real for me. I like to think of most of them as just as they are called: complimentary and alternative, not replacement. I recieved the quality attention and care I was craving, at a price but received nonetheless. I can see why people get into those things. Having someone focus their time into "healing" you, from a psychological sense is quite amazing. I suposse its somewhat akin to a placebo affect being therapeutic as well. Regardless it did no harm and stayed within its bounds, and I appreciated it thusly so.

 

As for NDs. For the most part its meh and they need to stay tightly in their scope of practice. I have a friend whom is finishing up 3rd year in Vancouver and they them self did a BSc at UBC and they have shown me how little they really do learn and says they definitely would not be comfortable stepping outside her bounds and cringes when colleagues think they have equal training to MDs(holy run on sentence batman). Luckily for her she knew all that going in, and is focusing her practice on the affluent Vancouver westside crowd and is fine with it.

 

While I think what you're saying has merit, you have to keep in mind that there's a fundamental difference between complementary and alternative medicine. So, while you can make the argument that people aren't always replacing mainstream medicine with these other forms, the fact is that in certain cases they are. And that can be quite dangerous.

 

Unfortunately, the general population isn't as informed about legitimate healthcare as we are. They place trust in anyone who has those fancy letters after their name (MD, etc.). So, anytime you're telling someone, from a position of supposed expertise, that they don't need a particular treatment, it can actually be very damaging. Yes, they take good care of you psychologically and are very attentive to your needs, but what's to stop a patient from assuming that this naturopathic treatment isn't all he/she needs? Ultimately, even if it's not the intention of the naturopath, the patient may end up missing out on important treatment.

 

There's also a really important distinction from a development standpoint. By definition, doctors (MDs) are willing to utilize any treatment that has proven efficacy (i.e. through large-scale, randomized clinical trials). The very fact that MDs uniformly speak out against naturopathy demonstrates that it simply doesn't have the data to back it up. If these options were tested (which they have been extensively), and were found to be effective, they would be transitioned into mainstream medicine. They wouldn't be "alternative." Thus,  that alternative/complementary designation, while not inherently a negative, means that they haven't made it through clinical trials and into approved clinical practice. Doctors are extremely apprehensive about anything outside of the mainstream medicine they learned in medical school. And rightfully so. 

[JohnGrisham]

While I think what you're saying has merit, you have to keep in mind that there's a fundamental difference between complementary and alternative medicine. So, while you can make the argument that people aren't always replacing mainstream medicine with these other forms, the fact is that in certain cases they are. And that can be quite dangerous.

 

Unfortunately, the general population isn't as informed about legitimate healthcare as we are. They place trust in anyone who has those fancy letters after their name (MD, etc.). So, anytime you're telling someone, from a position of supposed expertise, that they don't need a particular treatment, it can actually be very damaging. Yes, they take good care of you psychologically and are very attentive to your needs, but what's to stop a patient from assuming that this naturopathic treatment isn't all he/she needs? Ultimately, even if it's not the intention of the naturopath, the patient may end up missing out on important treatment.

 

There's also a really important distinction from a development standpoint. By definition, doctors (MDs) are willing to utilize any treatment that has proven efficacy (i.e. through large-scale, randomized clinical trials). The very fact that MDs uniformly speak out against naturopathy demonstrates that it simply doesn't have the data to back it up. If these options were tested (which they have been extensively), and were found to be effective, they would be transitioned into mainstream medicine. They wouldn't be "alternative." Thus,  that alternative/complementary designation, while not inherently a negative, means that they haven't made it through clinical trials and into approved clinical practice. Doctors are extremely apprehensive about anything outside of the mainstream medicine they learned in medical school. And rightfully so. 

For sure and I agree fully with your additional points, that's why i said I appreciated that they stayed within their scope. 

 

The problem is though, even in mainstream medicine, not everything is as clear as you may think. That of course is not a rational to promote alternative forms, but a thought as to why people may be attracted elsewhere. 

Strictly speaking that those complimentary (suppose alternative was the wrong word!) practices have a place for some people, as long as they stay within their scope and not replace evidence based medicine either. So essentially more education and counselling of patients on. Patient education. Patient education. Patient education.

 

It really is a multi-faceted issue, that directly stems from a culmination of educational resources, lack of healthcare funding that leads MDs to spend so little time with patients, and a whole slew of other factors. Taking the US as an example, there are numerous populations of people who are so severely undereducated (relatively), that there is a lot more in the realm of misinformation. This is my plug for educational reform, and teaching more life skills in the education system.

 

I got a bit off track.

My point stands though, as long as people stay within their scopes and don't overextend - then i'm satisfied.

[Fleming]

For sure and I agree fully with your additional points, that's why i said I appreciated that they stayed within their scope. 

 

The problem is though, even in mainstream medicine, not everything is as clear as you may think. That of course is not a rational to promote alternative forms, but a thought as to why people may be attracted elsewhere. 

Strictly speaking that those complimentary (suppose alternative was the wrong word!) practices have a place for some people, as long as they stay within their scope and not replace evidence based medicine either. So essentially more education and counselling of patients on. Patient education. Patient education. Patient education.

 

It really is a multi-faceted issue, that directly stems from a culmination of educational resources, lack of healthcare funding that leads MDs to spend so little time with patients, and a whole slew of other factors. Taking the US as an example, there are numerous populations of people who are so severely undereducated (relatively), that there is a lot more in the realm of misinformation. This is my plug for educational reform, and teaching more life skills in the education system.

 

I got a bit off track.

My point stands though, as long as people stay within their scopes and don't overextend - then i'm satisfied.

 

Yeah, that's fair. I just don't know that the world "needs" naturopaths, even if the harm that they may/may not do can be mitigated by staying within their own realm. 

[JohnGrisham]

Yeah, that's fair. I just don't know that the world "needs" naturopaths, even if the harm that they may/may not do can be mitigated by staying within their own realm. 

I think their must be an intrinsic need  for compassion and conversation from someone who's interested in you, from a mental health and well being perspective that is , otherwise people wouldn't be going to these types of practitioners.  I am speaking more broadly in this sense though, as I don't think NDs are all that necessary from their medical perspective - rather than their wellness perspectives that the individuals whom take on those roles tend to display. 

 

 

 

 

 

[NutritionRunner]

Some people go to naturopaths because the naturopath actually takes the time to listen to them, and tries to address the person as a complete individual, in a holistic manner.  Now, I don't agree with the non-evidenced based stuff that naturopaths do, and I greatly dislike how they push weird diets on people that have no scientific evidence, but the fact is, some people like having a professional who listens to them and their concerns.  A lot of doctors don't take the time to listen to their patients, they are always rushing to see the greatest number of patients, or set time limits on appointments, or say they can only address one problem per appointment (when people with multiple problems usually have them all interacting).  Thankfully I have a family doctor who takes the time and listens to her patients.  It means she's often running late, but I'd rather wait 30 minutes past my appointment time than be rushed when I see her.

 

I don't agree with naturopathic medicine at all, but I think conventional medicine could learn something from them:  how to take the time to treat the patient as a complete individual (including all the social determinants of health) and to actually listen to the patient and their complaints.

 

People also want more than just a prescription to fix what's wrong with them.  They want lifestyle interventions, but often don't know where to start.  MDs don't have enough education on a lot of lifestyle factors (exercise, nutrition, etc.)  More MDs should refer to registered dietitians for patients that want dietary counselling.  FHTs and CHCs are great for that.  Sadly, a lot of people don't have access to that kind of care.  I love the CHC where I work because the MDs and NPs make a lot of referrals to the RD team.  Patients might not need to go on a statin or metformin, or stuff like that if their condition is mild and can be helped with diet and exercise modifcations.  MDs need to be better at making the appropriate referrals instead of reaching for the prescription pad.  That's the other reason people go to naturopaths - they aren't given a prescription to "fix" their problems (although too many naturopaths do try to sell them supplements or strange diets).

[JohnGrisham]

Some people go to naturopaths because the naturopath actually takes the time to listen to them, and tries to address the person as a complete individual, in a holistic manner.  Now, I don't agree with the non-evidenced based stuff that naturopaths do, and I greatly dislike how they push weird diets on people that have no scientific evidence, but the fact is, some people like having a professional who listens to them and their concerns.  A lot of doctors don't take the time to listen to their patients, they are always rushing to see the greatest number of patients, or set time limits on appointments, or say they can only address one problem per appointment (when people with multiple problems usually have them all interacting).  Thankfully I have a family doctor who takes the time and listens to her patients.  It means she's often running late, but I'd rather wait 30 minutes past my appointment time than be rushed when I see her.

 

I don't agree with naturopathic medicine at all, but I think conventional medicine could learn something from them:  how to take the time to treat the patient as a complete individual (including all the social determinants of health) and to actually listen to the patient and their complaints.

 

People also want more than just a prescription to fix what's wrong with them.  They want lifestyle interventions, but often don't know where to start.  MDs don't have enough education on a lot of lifestyle factors (exercise, nutrition, etc.)  More MDs should refer to registered dietitians for patients that want dietary counselling.  FHTs and CHCs are great for that.  Sadly, a lot of people don't have access to that kind of care.  I love the CHC where I work because the MDs and NPs make a lot of referrals to the RD team.  Patients might not need to go on a statin or metformin, or stuff like that if their condition is mild and can be helped with diet and exercise modifcations.  MDs need to be better at making the appropriate referrals instead of reaching for the prescription pad.  That's the other reason people go to naturopaths - they aren't given a prescription to "fix" their problems (although too many naturopaths do try to sell them supplements or strange diets).

Couldn't have said it better myself.

 

The problem is, MDs are government funded via FFS and if they spend "too much time" on one patient, they lose out deriving income from another patient. With overhead costs, it puts pressure on them to be more "efficient". The MDs, not necessarily on their own fault, don't have the time to "look at the complete individual". There are definitely those who strike a balance, like you said your personal GP, but many find it hard to do.  CHC and FHTs are great, but few and far between.  

 

NDs can charge whatever they want, to find the balance between cost and "patients", so they can account more for the extra time they spend with their patients.  There are some pretty interesting payment models that some NDs are using these days, if the people are willing to pay then that's their choice. 

 

Additionally, access to appropriate care - why aren't dieticians covered? Counsellors? Lets be honest, because it would mean less health care funding elsewhere. Both of those can do a lot of good for person, but alas the options to get access to one are limited unless you have the money to spend. 

 

It's always the problem of not enough money, and no matter how efficient you get or increases in technology - it's still going to be an issue.

 

 

[amichel]

Additionally, access to appropriate care - why aren't dieticians covered? Counsellors? Lets be honest, because it would mean less health care funding elsewhere. Both of those can do a lot of good for person, but alas the options to get access to one are limited unless you have the money to spend.

 

It's always the problem of not enough money, and no matter how efficient you get or increases in technology - it's still going to be an issue.

 

 

That's part of it maybe, but I also think it's partly that to benefit from these services, patients need to put in a lot of effort to make lifestyle changes, and honestly, most of them won't.

 

It comes down to number needed to treat really. How many diebetic patients do we need to send to a dietitian before one bad outcome will be prevented? Probably a lot, because most of them won't follow the recommendations given to them. In contrast, how many do we need to put on metformin? I'd guess a lot less, because most people will take a pill with few side effects.

 

I'm not trying to sound cynical, making lifestyle changes is really hard and most people won't do that. Until that changes, (good) drugs are probably more cost effective.

 

Now, if someone wants to see a dietitian, more power to them and I think it should be paid for. In fact, all chronic disease patients should probably see one at least once. I'm just not sure about the logistics of it.

[JohnGrisham]

That's part of it maybe, but I also think it's partly that to benefit from these services, patients need to put in a lot of effort to make lifestyle changes, and honestly, most of them won't.

 

It comes down to number needed to treat really. How many diebetic patients do we need to send to a dietitian before one bad outcome will be prevented? Probably a lot, because most of them won't follow the recommendations given to them. In contrast, how many do we need to put on metformin? I'd guess a lot less, because most people will take a pill with few side effects.

 

I'm not trying to sound cynical, making lifestyle changes is really hard and most people won't do that. Until that changes, (good) drugs are probably more cost effective.

 

Now, if someone wants to see a dietitian, more power to them and I think it should be paid for. In fact, all chronic disease patients should probably see one at least once. I'm just not sure about the logistics of it.

Yeah fair, but seems like a circular reference to me. They can't make those changes, if they don't have the chance to actually see those practitioners? 

 

Additionally, being on drugs for life, versus putting in the work to make real change - i would take the later, if it is an option depending on the specific case of course. 

 

There are some things that drugs work, but aren't necessarily the best choice long term. And then there are things where drugs are absolutely necessary, and no amount of exercise or proper diet can help.

 

 

 

[amichel]

Yeah fair, but seems like a circular reference to me. They can't make those changes, if they don't have the chance to actually see those practitioners?

 

 

Except we know (there's plenty of research) that most won't make the changes even if given the opportunity. It's a stages of change type thing. It makes sense to refer patients who are really motivated and therefore have the best chance of benefitting from such a service, but maybe not those who don't seem ready to make changes.

[makingfetchhappen]

I don't see why we have put a system in place that makes naturopaths seem so legitimate. We even let them call themselves doctors. It has a real effect in the average person's perception IMO.

 

A lot of people seem to think that this is on the same level as actual medicine. Why wouldn't they if we have a system where they go to school for 8 years and then have a designation? Not everyone has the time, ability, or even interest in educating themselves on all of this stuff. 

 

If people want someone to listen to them more, why don't we expand the role of pharmacists? You can already ask retail pharmacists questions about your health. Why not have them schedule appointments where  they can sit down and discuss whatever is bothering them? They could charge like $60 for a half hour session. Obviously you would need to have 2 pharmacists at this point, one behind the counter and the other in consultations. This would allow the consulting pharmacist to give their full attention to the person who booked the appointment. 

 

If people want to go into their health concerns in detail, why not do it with someone who is actually trained in an evidence based program? 

[JohnGrisham]

Except we know (there's plenty of research) that most won't make the changes even if given the opportunity. It's a stages of change type thing. It makes sense to refer patients who are really motivated and therefore have the best chance of benefitting from such a service, but maybe not those who don't seem ready to make changes.

Fair point, but at this point - even if you are motivated, it would be out of pocket and not covered. Unless i'm mistaken? 

[amichel]

Fair point, but at this point - even if you are motivated, it would be out of pocket and not covered. Unless i'm mistaken?

Depends. Here in Alberta lots of family docs are in primary care networks which means it is covered.

 

Regardless, as I've said already, I 100% agree that it should be covered. I was just trying to address the issue of why docs don't refer more people, and why it might not be the most cost effective thing to refer everyone.

[ralk]

Naturopathy is highly refined placebo-based medicine.

 

That's not a criticism, placebos work pretty well for a lot of things. The best naturopaths recognize this, and provide services which make individuals feel better without claiming they have real treatments or cures. Unfortunately, in large part because the profession teaches that naturopathy does have real treatments, these good naturopaths are few and far between. It's hard to be totally immersed in a field without drinking some of the KoolAid (physicians aren't immune to this either, we just have different KoolAid).

 

There are also better and worse placebos. Things like Acupuncture and Reiki involve a therapeutic relationship with rituals - these can be beneficial, take time and expertise to do, so they have some justification for their costs.They're not a science, but they are an art. Homeopathy, herbal medications and supplements are basically the worst parts of the pharmaceutical industry - expensive, useless, potentially harmful when manufactured incorrectly (which is frequently the case). Anything that is presented as an alternative to conventional treatments or standard medical advice, including dietary advice, can be actively harmful by going against evidence-based medicine.

 

Basically naturopathic medicine could have a useful role in health care and could complement traditional medicine. However, the way most naturopaths practice, those benefits aren't realized or are counteracted by significant downsides.