Naturopathic Medicine

[snacks]

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? 

 

I was actually looking at the website the other day and I can't help myself from posting what I learned: I don't think they're actually allowed to call themselves doctors yet, at least in Ontario! (http://www.ccnm.edu/prospective_students/faqs).

They're waiting for the proclamation of the Naturopathy Act, which seems to have been indefinitely delayed (http://www.collegeofnaturopaths.on.ca/CONO/News/Council_Updates/Proclamation_Delay.aspx).

 

On the other hand, Ontario has recently established a professional college of Homeopaths (http://www.collegeofhomeopaths.on.ca/docs/Proclamation%20News%20Release%20and%20Backgrounder.pdf). I heard some interesting comments from Matthew Stanbrook about how a professional college unfortunately does seem to legitimize homeopathy, but at the same time, it might actually be a good thing for patient safety (http://alturl.com/8t5fx).

 

[JohnGrisham]

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.

For sure, i don't think everyone should be referred. But those who are motivated and wanting to work, should have access  to them just as they have access to a FM doc. 

 

But again, this is all high level complex stuff that gets really convoluted and tricky super fast. There needs to be a residency of sorts that we can put these super smart high achievers into.

 

"I matched into HealthCare Reform Optimization!" 

[Mighty Molar]

Nowadays, so many degree/professions try to claim the tittle "Doctor" ) From chiro, natural med, homeo med, nurse (doctor of nurse practice?), pharmacist .... all the way to PhD in Fine Art ... which is kinda cool anyway.

 

Last time I went to a pharmacy, a pharmacist introduced himself as "Dr.". I really thought that he is an MD and start asking in more detail, until he said "Oh, I am just a pharmacist"

[The Ace of Spades]

Nowadays, so many degree/professions try to claim the tittle "Doctor" ) From chiro, natural med, homeo med, nurse (doctor of nurse practice?), pharmacist .... all the way to PhD in Fine Art ... which is kinda cool anyway

I'm just going to introduce myself by my first name and do away with the whole 'doctor' title. It means very little nowadays.

[medisforme]

We actually had an ND give us a lecture in second year on complementary and alternative medicine.  It was extremely informative.  The person giving the lecture was a proponent of ND's and MD's sharing patient information to provide the highest quality care possible to our patients.  A lot of the information presented was evidence based (nothing controversial; stuff like diet, exercise, reducing stress etc...).  I came away at least with somewhat of an open mind that there may be a place for ND's in patient care.

 

My main knock is that there is somewhat of a conflict of interest in a lot of the herbs/vitamins/supplements they are prescribing as they own/have a stake in naturopathic pharmacies which are connected to their practice.

 

My second knock is that some of them do not do thorough enough histories and physicals (i am not sure how much this is emphasized in their training) and often miss the obvious in their approach to patients.  I have a friend who went to an ND as he was c/o low energy/fatigue, low motivation etc... and ended up paying $1200 to have bloodwork done to assess possible allergies etc... apparently he is allergic to parsley, and advised to cut this out of his diet.  Knowing that he consumes copious amounts of alcohol i asked if this was discussed during his appointment and he said no.  I gave him some free advice that if he can cut down on having 6+drinks/day he would likely feel a lot better than cutting parsely out of his diet.

[Jaybird]

We actually had an ND give us a lecture in second year on complementary and alternative medicine.  It was extremely informative.  The person giving the lecture was a proponent of ND's and MD's sharing patient information to provide the highest quality care possible to our patients.  A lot of the information presented was evidence based (nothing controversial; stuff like diet, exercise, reducing stress etc...).  I came away at least with somewhat of an open mind that there may be a place for ND's in patient care.

 

My main knock is that there is somewhat of a conflict of interest in a lot of the herbs/vitamins/supplements they are prescribing as they own/have a stake in naturopathic pharmacies which are connected to their practice.

 

My second knock is that some of them do not do thorough enough histories and physicals (i am not sure how much this is emphasized in their training) and often miss the obvious in their approach to patients.  I have a friend who went to an ND as he was c/o low energy/fatigue, low motivation etc... and ended up paying $1200 to have bloodwork done to assess possible allergies etc... apparently he is allergic to parsley, and advised to cut this out of his diet.  Knowing that he consumes copious amounts of alcohol i asked if this was discussed during his appointment and he said no.  I gave him some free advice that if he can cut down on having 6+drinks/day he would likely feel a lot better than cutting parsely out of his diet.

 

What do naturopaths do that doctors can't? We don't know how to tell people "stop binge drinking and start going jogging"? Time constraints are a real enough issue, but that's a problem of administration, not of training, and besides, if we really, honest-to-god can't get enough family physician time to discuss lifestyle changes with patients, well, I'll take an NP over a quack any day. 

[GrumpyMoriarty]

I don't have a problem with addressing emotional/spiritual comfort or trying to see the holistic picture (and i'm sure most medical professionals would share the same opinion). What I do have a problem is with NDs (and homeopaths and various other quacks) trying to package all this as legitimate MEDICAL advice and charging a medical fee for these things. Emotional/spiritual comfort is undoubtedly important in various aspects of physical/emotional healthcare, but these should not be used as an excuse to sell placebos or fad diets at ridiculous prices that plainly do not work on a biological level. 

[NutritionRunner]

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.

 

At our centre, we find certain populations a lot more motivated to make change.  For example, we've found that recent immigrants, and especially those who were previously refugees, are extremely motivated to make changes.  We are frequently able to discharge patients from dietetic care because their HbA1c is back to normal, or their blood pressure is back to normal, or their lipids are back to normal, all because of dietary and other lifestyle changes.  We've found that with motivated patients, these lifestyle changes can make all the difference.

 

Populations that have more challenges include those with mental health issues, those with food insecurity issues, and those who don't have a lot of self-efficacy, or who aren't at the right stage of change (if you use Prochaska's stages of change, they aren't at the action stage yet, although we can help those at the preparation stage get ready to move into the action stage).  For the self-efficacy issue, we offer a lot of cooking workshops, so people can become more confident in their cooking skills.

 

It's great to work in a multi-disciplinary environment where the MDs and NPs make frequent referrals to the dietitians.  I wish more in primary care did so.  We DO see changes.  We dietitians are trained in motivational interviewing and other such techniques, to help patients identify their own strengths and weaknesses, and what changes they think they can make.  Dietary changes DO make a difference.  Even if they are small, and even if patients still need to be on medications, dietary changes can often reduce the dosage of medications, or improve quality of life.

[amichel]

At our centre, we find certain populations a lot more motivated to make change. For example, we've found that recent immigrants, and especially those who were previously refugees, are extremely motivated to make changes. We are frequently able to discharge patients from dietetic care because their HbA1c is back to normal, or their blood pressure is back to normal, or their lipids are back to normal, all because of dietary and other lifestyle changes. We've found that with motivated patients, these lifestyle changes can make all the difference.

 

Populations that have more challenges include those with mental health issues, those with food insecurity issues, and those who don't have a lot of self-efficacy, or who aren't at the right stage of change (if you use Prochaska's stages of change, they aren't at the action stage yet, although we can help those at the preparation stage get ready to move into the action stage). For the self-efficacy issue, we offer a lot of cooking workshops, so people can become more confident in their cooking skills.

 

It's great to work in a multi-disciplinary environment where the MDs and NPs make frequent referrals to the dietitians. I wish more in primary care did so. We DO see changes. We dietitians are trained in motivational interviewing and other such techniques, to help patients identify their own strengths and weaknesses, and what changes they think they can make. Dietary changes DO make a difference. Even if they are small, and even if patients still need to be on medications, dietary changes can often reduce the dosage of medications, or improve quality of life.

All of that is great. I don't disagree with you at all. I just think the compliance with meds is probably higher, that's all.

[Mighty Molar]

and soon enough, nurse-doctor (doctor in nurse practice) will try to take over the primary care sector 

[bakercyclist]

I don't think has been posted yet, but in the next few months NDs are being moved from the Drugless Practitioners Act to the Regulated Health Professions Act, and are being granted prescribing rights along with that, but apparently are losing some lab access (probably a good thing, though they're asking people to send letters to complain about it). Here's a blog post with more info: http://blog.naturopathicfoundations.ca/2015/05/update-on-naturopathic-move-to-rhpa.html

 

I have more friends that are NDs than MDs (I know, right? Hopefully that changes soon), but I only have one friend that can afford to actually see an ND regularly, and she also sees her doctor regularly, thank goodness. There are some aspects of naturopathy that I don't mind, but I try not to worry about the other aspects because the price point makes it inaccessible to most people anyway.

 

What's a polite way to ask someone with a BSc and Bachelor of Naturopathy what their stance is on homeopathy and why?

[Robin Hood]

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.

 

I just saw you were accepted.

 

Congratz!

[Robin Hood]

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? 

 

Well, a pharmacist can't prescribe treatments. 

Also, people seem to just see PharmDs as pill sellers.

[Robin Hood]

Naturopathy and Chiropratic should be considered as practicing medicine without a license.  

[Tacrolimus]

Well, a pharmacist can't prescribe treatments. 

Also, people seem to just see PharmDs as pill sellers.

Incorrect. Pharmacists in Alberta can prescribe independently if they have "APA" which requires one year of experience and an application to the college. For most of Canada, yes, that is true but it will likely change in five years.

 

Anyways, on the topic of naturopathy and homeopathy, something we were taught was that if it poses no risk to the patient (i.e. no drug or disease interaction or they are on warfarin), and the patient likes it, there is no point in arguing with them. People have their beliefs and your 10 minute talk will probably do more harm than good. In an ideal world, would we stop them? Absolutely, but patients are strange. Good discussion though.

[Robin Hood]

Incorrect. Pharmacists in Alberta can prescribe independently if they have "APA" which requires one year of experience and an application to the college. For most of Canada, yes, that is true but it will likely change in five years.

Anyways, on the topic of naturopathy and homeopathy, something we were taught was that if it poses no risk to the patient (i.e. no drug or disease interaction or they are on warfarin), and the patient likes it, there is no point in arguing with them. People have their beliefs and your 10 minute talk will probably do more harm than good. In an ideal world, would we stop them? Absolutely, but patients are strange. Good discussion though.

I won't be surprised to see more prescription rights for pharmacists in the future, but this will involve a conflict of interest.

[amichel]

Incorrect. Pharmacists in Alberta can prescribe independently if they have "APA" which requires one year of experience and an application to the college. For most of Canada, yes, that is true but it will likely change in five years.

 

Anyways, on the topic of naturopathy and homeopathy, something we were taught was that if it poses no risk to the patient (i.e. no drug or disease interaction or they are on warfarin), and the patient likes it, there is no point in arguing with them. People have their beliefs and your 10 minute talk will probably do more harm than good. In an ideal world, would we stop them? Absolutely, but patients are strange. Good discussion though.

 

Yes but that motto discounts the fact that many people choose naturopathic treatments INSTEAD of real ones.  That's the issue. 

 

I was reading somewhere the other day (haha so vague) and someone was saying that we should stop calling it complementary and alternative medicine and just switch to complementary, because alternative implies that you can take the naturopathic remedies alone. 

[Robin Hood]

Yes but that motto discounts the fact that many people choose naturopathic treatments INSTEAD of real ones.  That's the issue. 

 

I was reading somewhere the other day (haha so vague) and someone was saying that we should stop calling it complementary and alternative medicine and just switch to complementary, because alternative implies that you can take the naturopathic remedies alone. 

 

It should be called quakery. 

[amichel]

It should be called quakery.

True but that doesn't really lead to a trusting doctor patient relationship haha.

[medhope15]

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[A-Stark]

I think you're drinking the ND koolaid. They certainly treat a variety of mostly fictional vitamin "imbalances", to say nothing of fake endocrine diagnoses like adrenal "fatigue" or "exhaustion". You don't get to claim to be "holistic" when you don't have anything more than a rudimentary understanding of disease pathophysiology, let alone one that isn't entirely warped by naturopathic philosophy. 

 

 

Mostly healthy people without actual significant disease will not have serious vitamin or any other nutritional deficiencies. This is especially true of most "worried well" types who visit naturopaths. I don't really need to know the minutiae of a patient's diet, though it's often fairly obvious when they have a bottle of Pepsi at the bedside and have a BMI of 50. 

 

And stool assessments? Why? That's tantamount to reading the tea leaves in a teacup, except that it actually entails divining an interpretation of the shit floating (or sinking!) in the toilet bowel. 

 

Essentially naturopaths order unnecessary bloodwork and bogus allergy testing, which they then use to diagnose subclinical or invented diagnoses that have no (or wildly implausible) pathologic correlates. Consider examples such as systemic candida, chronic lyme disease, multiple chemical sensitivity, interstitial cystitis, etc. 

 

If I seem overly cynical, I do believe it's well warranted. See this one linked above: https://www.sciencebasedmedicine.org/nd-confession-part-1-clinical-training-inside-and-out/ 

 

But I also once went to a talk given by naturopaths about gluten. There was much talk about gluten "intolerance" and "inflammation" in very vague, hand-wavy terms. They did talk about Celiac disease a bit, but didn't seem to understand the pathophysiology and repeatedly mispronounced associated conditions, along with other immune-mediated diseases. Of course, the mainstay of treatment was a gluten-free diet even in the absence of Celiac disease or actual, documented wheat allergy. And they talked about vitamins a lot. They also attempted to relate gluten to a variety of autoimmune conditions that are not at all associated with Celiac disease. 

 

By the way, when it comes to diet and lifestyle and health, these are only proximal factors that are primarily determined by social factors, i.e. the social determinants of health. Low income people are more likely to have lack of income, food, and housing security, more likely to smoke, more likely to be involved in substance abuse and be affected by crime, and likely to have poorer access to health care. They don't have money for gym memberships, regular recreation, or the kind of wishy-washy lifestyle counselling provided by naturopaths. 

 

Otherwise, I despise the notion that there is anything "holistic" about naturopathy or that this term has any meaning whatsoever. They simply use this term so that they can criticize "conventional" or "Western" physicians for ignoring "root causes" and other BS. 

 

The worst part about NDs is that they don't know what they don't know. Their education is not remotely comparable to anything an MD receives, and that even goes for those MDs that not that great or outright bad. The only really dangerous practitioner is one who lacks the experience and insight to understand  his own lack of competence - and the difference between pathological science and pseudoscience - and naturopathy is full of the latter and sparse on the former. 

 

The knowledge base required to pass, say, a Royal College examination is extremely detailed and often very wide depending on the specialty. I wouldn't trust a naturopath to be able to pass a second year med school OSCE. 

[JohnGrisham]

A-Stark beat me to it, and saved my fingers alot of typing!

[amichel]

I think you're drinking the ND koolaid. They certainly treat a variety of mostly fictional vitamin "imbalances", to say nothing of fake endocrine diagnoses like adrenal "fatigue" or "exhaustion". You don't get to claim to be "holistic" when you don't have anything more than a rudimentary understanding of disease pathophysiology, let alone one that isn't entirely warped by naturopathic philosophy. 

 

 

Mostly healthy people without actual significant disease will not have serious vitamin or any other nutritional deficiencies. This is especially true of most "worried well" types who visit naturopaths. I don't really need to know the minutiae of a patient's diet, though it's often fairly obvious when they have a bottle of Pepsi at the bedside and have a BMI of 50. 

 

And stool assessments? Why? That's tantamount to reading the tea leaves in a teacup, except that it actually entails divining an interpretation of the shit floating (or sinking!) in the toilet bowel. 

 

Essentially naturopaths order unnecessary bloodwork and bogus allergy testing, which they then use to diagnose subclinical or invented diagnoses that have no (or wildly implausible) pathologic correlates. Consider examples such as systemic candida, chronic lyme disease, multiple chemical sensitivity, interstitial cystitis, etc. 

 

If I seem overly cynical, I do believe it's well warranted. See this one linked above: https://www.sciencebasedmedicine.org/nd-confession-part-1-clinical-training-inside-and-out/ 

 

But I also once went to a talk given by naturopaths about gluten. There was much talk about gluten "intolerance" and "inflammation" in very vague, hand-wavy terms. They did talk about Celiac disease a bit, but didn't seem to understand the pathophysiology and repeatedly mispronounced associated conditions, along with other immune-mediated diseases. Of course, the mainstay of treatment was a gluten-free diet even in the absence of Celiac disease or actual, documented wheat allergy. And they talked about vitamins a lot. They also attempted to relate gluten to a variety of autoimmune conditions that are not at all associated with Celiac disease. 

 

By the way, when it comes to diet and lifestyle and health, these are only proximal factors that are primarily determined by social factors, i.e. the social determinants of health. Low income people are more likely to have lack of income, food, and housing security, more likely to smoke, more likely to be involved in substance abuse and be affected by crime, and likely to have poorer access to health care. They don't have money for gym memberships, regular recreation, or the kind of wishy-washy lifestyle counselling provided by naturopaths. 

 

Otherwise, I despise the notion that there is anything "holistic" about naturopathy or that this term has any meaning whatsoever. They simply use this term so that they can criticize "conventional" or "Western" physicians for ignoring "root causes" and other BS. 

 

The worst part about NDs is that they don't know what they don't know. Their education is not remotely comparable to anything an MD receives, and that even goes for those MDs that not that great or outright bad. The only really dangerous practitioner is one who lacks the experience and insight to understand  his own lack of competence - and the difference between pathological science and pseudoscience - and naturopathy is full of the latter and sparse on the former. 

 

The knowledge base required to pass, say, a Royal College examination is extremely detailed and often very wide depending on the specialty. I wouldn't trust a naturopath to be able to pass a second year med school OSCE. 

 

Thank you! I was about to take that on but gave up. 

[medhope15]

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[JohnGrisham]

I agree with many of your sentiments medhope15, I too know a few good NDs in practice, but the problem is the larger majority follow  A-starks description.

 

Many follow the businessy, lifestyle approach which to be honest is more psychological than medical in most cases. Which isn't a bad thing, but to claim certain medical efficacies isn't quite a fair thing to do - and hard to stomach. I've sat in on my fair share of presentations (my partner is in an related allied health field), and the times I cringe about the total lack of basic rudimentary understanding of immunology and biochemistry is numerous.  A lot of it is preying in a way, on the lack of knowledge of the general public - throw in fancy science words (despite completely wrong contexts) and you sound like an amazing great alternative. Oh and don't forget to buy these 89.99$ vitamin regiment, it will help fight the toxic t-cells in your body. *facepalm*. The "big pharma" doesn't want you to know about these, because they will lose all their profits on drugs from the MDs.  

Don't get me wrong, I am equally critical and cynical about big pharma, doesn't mean I'm going to tolerate those who don't know what they are talking about when in a perceived position of power. ND, MD, PT, yada yada, If you're in the medical profession and pitching nonsense, my vote of confidence goes down. Not that it would matter to them anyways hah.