Today’s guest blog comes courtesy of Psychiatrist, Dr. Rob Tarzwell, M.D. Anyone interested in writing guest blog should submit a proposal to the editor, skepticnorth [at] gmail [dot] com
Guest Post – Rob Tarzwell: The Naturopath Identity Crisis
In BC, naturopaths were granted prescribing privileges in April 2009. Ontario has just followed suit. The particulars of prescribing are yet to be worked out in BC, and actual prescriptions have not begun to flow into pharmacies. So, naturopaths move a step closer to being more like physicians by dint of responsibilities and privileges, but are they?
Here is a statement about naturopathy from the BC Naturopathic Association (www.bcna.ca):
Q: How are NDs Different From Regular Physicians?
A: A Naturopathic Physician is trained in the methods of treatment commonly referred to as alternative medicine. When you see an ND for health care your treatments may include therapeutic diet, exercise and other lifestyle changes, such as a stop smoking program, herbal medicines, nutritional medicines, manual manipulation or physical therapies. Your naturopathic physician may refer you for massage, acupuncture or midwifery services as needed. You and your chosen ND would work together to determine the best possible treatments available including those traditionally provided by specialists such as cardiologists, allergists, pulmonary specialists and so on.
Spend your money as you please and caveat emptor, just as long as the seller (as a health-care practitioner in a situation of inherent power imbalance) remembers the fiduciary responsibility to be honest about their training, their treatments, and the data supporting those treatments. That means not saying things like “Naturopathic Medical Education – An Eight Year Accredited Medical Degree Program” when it is, in fact, a 4 year degree undertaken at a college that has no connection to any public university, nor to any robust faculty of science (thus being free of all legitimate and penetrating scrutiny), following 3 or 4 years of undergraduate work. Has your naturopath ever made a point of telling you that?
Also, despite my rather pedestrian medical education, I was most certainly trained in such alternative treatments as smoking cessation, diet, and exercise. Come to think of it, I’ve never met a single human being with a high school education who doesn’t already know they should stop smoking, lose a little weight, and exercise more. If that’s alternative, I’d sure like to know what it’s alternative to.
Now, as to herbal medicines, nutritional medicines, and manual manipulation, I’ll readily grant those as “alternative.” I prefer a more blunt term: unproven. Naturopaths are perfectly free to apply for research funding via the Canadian Institutes for Health Research to seek evidence. Then again, maybe they don’t have to. Let’s not forget the already $2.5 billion US spent, demonstrating an epic fail for alternative remedies. So, here’s an even blunter synonym for alternative (in this case): disproven.
Here then, there appears to be a genuine difference between naturopaths and physicians. I may be hard-headed, but the data from $2.5 billion in research showing no effect would even change my mind about my patterns of practice. So, what have naturopaths done with the mountains of data from this unprecedentedly vast and penetrating examination of their practices and recommendations? The sound of one hand clapping comes to mind.
On the question of allergy testing, it seems disingenuous for MDs to claim this as a specialty. Allergy and immunology is one of the disciplines that the public has most associated with naturopathic medicine over time. Many patients attend naturopathic medical clinics for this reason specifically, as conventional medicine has little to offer in the area of allergy treatment. For many decades medical doctors didn’t even believe in or treat allergies.
Little to offer? Disingenuous? Hmm, I hope none of my specialist colleagues in… in – what is it they call it again? Oh, yes, Allergy and Immunology – find this page. No, wait, too late. They have found it. Surprise, surprise, they’re quite concerned about naturopaths finding all sorts of allergies which don’t appear to exist except in their own labs, resulting in kids ending up half-starved from diets of extreme restriction. There’s that whole evidence problem again (and by the way, didn’t naturopaths mention allergists as one of the “specialists” they would work together with? Just for fun, go back up and read the last sentence of the first quotation from the BCNA website).
So, overzealous claims to training, a refusal to reject disproven practices despite evidence screaming in their faces, and positive contempt – to the point of ridiculously basic factual error about the existence of an entire medical specialty. Is this who you want treating your grandmother?
Don’t answer that yet. First, a brief but important segue. Why do physicians care about evidence so much? Here, I will speak for myself. I am bombarded with magazines, fliers, drug company reps with short skirts and low-cut tops (I’m not kidding about that!), offers to attend fancy dinners, and conference swag by the kilogram, all trying to influence what I write on that white pad. I’m a sucker like everyone else and I know that stuff has the potential to influence me. My only hope is reliable scientific literature. The kind that is peer-reviewed, so that people you will never meet do their best to shred your findings. I’ve been both a shredder and a shreddee. It’s more fun being the shredder, but it still takes dozens of hours of unpaid time just to do a decent job as a peer reviewer on a single paper.
Science looks so tedious and slow in journals, so tentative. But when it really matters, when it’s in your veins, it sometimes leads to shouting matches at scientific meetings, where you meet people actually passionate about data and results. Yes, we do get seduced by our own pet theories. Of course. But we also, slowly, reluctantly, do come around in the face of incontrovertible data. And the naturopaths? Did I mention the $2.5 billion dollars?
Q: What About Patient Safety? If Naturopathic Physicians Haven’t Dealt With Prescription Drugs in the Past, How are they Eligible for the Added Responsibility?
A: Naturopathic doctors deal with prescription medicines on a daily basis: With patients already on a drug regime, considering pharmaceuticals and/or an alternative, drug/non-drug interactions, and myriad other interconnected health issues. The substantial change with new regulations won’t be so much an added responsibility, but rather the ability to improve patient care. Currently, hundreds of thousands of BC
residents see naturopathic doctors for care, many for primary care, and BC licensed NDs attend to over a million patient visits each year.
Let’s see if I understand this. Naturopaths see patients taking prescription medications on a daily basis, so jumping in and prescribing won’t be an added responsibility but rather an improvement. I ride the bus to work, every day. This means, I deal with the bus on a daily basis. Just about every day I ride the bus, there’s always some little mechanical problem here or there. The bus knocks or pings. A seat is loose. One of the emergency window pop-out latches won’t close. Every day, for years, I’ve seen this, for thousands of bus rides. I have seen and considered the myriad other interconnected bus safety and function issues. By BCNA logic, for me to become a bus mechanic wouldn’t be an œadded responsibility but an improvement.
So which is it? Physicians in name only who want it both ways, or misunderstood and maligned colleagues? Why don’t I give the last word to the naturopaths themselves:
Q: Don’t Naturopathic Doctors Only Use Natural Medicines?
A: No and yes.
Kinda says it all.
Rob Tarzwell is a Vancouver Psychiatrist who completed is medical school at the University of Manitoba, and his residency in Psychiatry at Dalhousie in Halifax. He currently practices part time and is back in school studying Nuclear Medicine at UBC.