Dear Harriet Hall, MD-
I chose the word Ostrich, because I see your head is buried in the sand and your ass is likely waving in the air. You have recently written for a pseudo-popular magazine that has a mission of targeting anything they don't "believe" in and call it pseudoscience. Unfortunately, reading through your 6 column, 2 page diatribe against naturopathic medicine, your talking points were off target. I am sorry you don't understand what naturopathy is. You said so in your first paragraph, yet still felt entitled to dissect and discredit something you just admitted you didn't understand. You did some random research. You made a lot of gross generalizations and tried a lot of scare tactics. You made up long stories to discredit people using the same rationales you were dismissing.
As a practicing naturopath in a licensed state, I see all sorts of patients for many reasons. Many, but not all, have health insurance and a primary care doctor. When I, or my colleagues see them, they are at their wit's end. They have been getting medicated to death for years with no health improvements in sight. Their MDs have stopped looking at them or touching them. How many times have I been told that I have given them the only physical they have ever had since grade school? How many times have I observed obviously overlooked signs and symptoms because they have been on the medication plan with no change for years? Maybe their doctor has overlooked the obvious labs- anemia, elevated glucose, hypothyroidism (starts at 3.0, not 4.5- that's just a lab reference range- you should look that up)- or disregarded them as "emotionally disturbed". Just wrote them off as obese but didn't talk about the health risks- just wrote another script. I'd be emotionally disturbed if I had been taking anti anxiety meds and insomnia meds for years because my MD couldn't figure out I needed progesterone- not Ambien. And yes, fibromyalgia is very real, especially to the people who live with it. It's got a diagnosis code now, so it must be real, right?
You say we can do whatever we want, think whatever we want. I guess when all MDs are only primary care physicians who have exactly the same understanding of all their patients and practice in exactly the same manner and all patients are cured, I will agree that variety in our professional field has got to be stopped. "It is so nebulous that it allows its practitioners to believe and do almost anything." Mighty fine skeptic argument there. Sounds like voodoo. "It"?
For the record, the reason naturopathic medicine is not universally recognized is because of money. The AMA has at its core a mission to wipe homeopathy and naturopathy off the professional field. They spend their lobby dollars fighting our lobby dollars. Our lobby dollars fight for licensing and higher medical standards. We are challenged by MDs, who also challenged the DOs until they co-opted them. We are challenged by chiropractors who were challenged by MDs. We are challenged by people who go to school in unlicensed- and therefore unregulated states- who want the title but not the education. You suggest we are encouraged to sell supplements at our clinics. MDs make money selling supplements as well, also getting lots of free lunches, supplies and fabulous resort dinners from their suppliers. Except the MD world is owned by big pharmacy and big insurance, and we are not. Look at Cancer Treatment Centers of America, they are some of our proudest supporters. We are part of the whole team. Last year, I was hired by a hospice to help develop a program for their patients seeking touch therapy and acupuncture for pain and anxiety. Sadly, since Medicare wouldn't pay for it and our state budget axed, it could not be implemented. I guess alternative care is only good for rich or stupid people.
You are right, we are not trained in emergency medicine to the degree MDs are. Mostly because we are denied access to the training we have sought there, and because we are trained as primary care physicians. Many of us have to get that extra training on our own, working in clinics and shadowing MDs who agree to mentor us. As the vast majority of practicing physicians in the United States are neither ER doctors or surgeons, it is ultimately irrelevant. (I have a great rapport with surgeons, they appreciate my understanding of the process (too many questions) and my deep knowledge of anatomy- surprise!). I have more tools in my medical bag for diagnosis than just my Welch Allens and and a lab order form. I have been able to get people into the ER who have been mismanaged by their primary care doctors. I have saved lives. Do I do this every day? No. Have I prevented people from serious health injury? Yes, many times over. When it is out of my skill level, I refer to a specialist- maybe another naturopath, maybe a chiropractor, maybe an MD/DO. I work with the MD and DO community, I am not an adversary. Almost all my patients openly share my care plan with their PCP or their cardiologist or GI doc. I get referrals. Because their patients are eating better, doing better, feeling better, and taking better care of themselves. Because I take the time. (oh, and the labs prove it as well)
"They encourage home births but are not trained to do surgery, so what happens if their patient develops a an emergency at home that requires a life saving C section?" Probably what any reasonable person would do, call 911. Except if a naturopath is licensed for homebirth, they are probably a trained midwife, and have an extensive care plan already in place with their patient. A primary care physician would have no better plan to treat a patient going into labor in their office. Did you know that the meta analysis saying home birth was more dangerous and had worse outcomes was recently dismissed as deeply flawed, pointedly biased, and has been debunked? Check it out, it was on MedScape last week. Oh, yes, we read that too. Our totally ridiculous (per your friend at NEJM) naturopathic textbook is also in the library on First Consult. Thank goodness NEJM has never been challenged for publishing questionable studies that have been proven to be falsified and funded entirely by the pharmaceutical and surgical supply industry. No fake data or flawed meta- analyses ever happened there, or sham studies. Or conflict of interest.
Dr Hall, I understand your frustration. Last year I was at a conference on hormone replacement and anti aging. Many of the MDs in the crowd looked pale and aghast, they had no idea what the other physicians were talking about. They were there to find out a way to implement a turnkey practice into their existing practices to generate tons of cash pay patients. Using nutrition? That's unHEARD of. Selenium deficiency replaced in tiny amounts can reverse simple peripheral thyroid resistance? But that's a freaking mineral you can get at Trader Joe's. How come we didn't know that fluoride, chlorine and bromides selectively displace iodine and that they are in 100% of our water and food supply? How come we were giving progestins all these years, giving women breast cancer and heart attacks and strokes without once questioning the profit margin of big pharma? Bio-identical is unproven! Really? We are made of bio-identical. That is what it means, that which is identical in composition to that which the human body already makes. Has made. For millennia. No proof at all.
I have been hospitalized twice for major injuries in the last five years, and I am really grateful for all the doctors, nurses, medics, CNAs, residents, surgeons, CT and MRI techs, cleaning ladies (and gents) and the kitchen staff for being there. They knew their stuff (except how to give benadryl to a patient who is having a very itchy reaction to the IV morphine at 3 am, liver qi...). My orthopod and my neurosurgeon both acknowledged my superior healing rate. I mean, not only was I well into my mid thirties and not on any medication, I had no illnesses, and I healed as fast as a much younger person. "Keep up what you're doing." You know, the vitamins, minerals, herbs, and homeopathy. In fact, I work for a pain management doc part time. For my amazing insight into the complete health of her disabled patients, finding simple things like undiagnosed fevers, untreated hypertension, misprescribed hormone replacement, unmanaged diabetes. My ability to relate to them, and touch them in a way that relieves pain on the spot, and can allow them to walk out of the room in less pain than they arrived in. How's that for magic!
Am I working on a belief system? You betcha! I use science, which is empirical. I use traditional labs. I use alternative labs, when traditional labs are insufficient. Are they illegal or alien? No, just not common. I use chinese medicine. It is more useful for many of my chronic allergy patients who don't respond to all the OTC and prescription meds. Do I use nature cure? When it's feasible. Compliance is key. Do I prescribe antibiotics? When it's appropriate, which is often enough. Are all fevers a life threatening emergency in children? No. (I also don't do pediatrics, as there are docs who focus on that, and I don't. I am GREAT with menopausal crazy ladies, though.) Would I vaccinate my own children? Probably, just not each and every shot. Do patients have the right to seek their own treatment and make their own health decisions? Absolutely. Will some patients die in my care? Some day. Many people die when ill and under a doctor's care. That doesn't mean I am the cause of death. Iatrogenic caused illness is the third leading cause of death in this country, including properly prescribed meds. That's pretty serious.
If you don't believe in Qi, or the life force, you probably should be teaching anatomy and not going into patient care. If you can't tell the difference, you don't look closely enough at your patients. If you can't tell from the way they walk into your room, from the color of their skin and eyes, the droop of their cheek, the shuffle of their legs, the sound of their voice, and get a really good sense of their vitality, you aren't in the health business. Just sickness management. And that is probably where we diverge. I have a goal to help my patients become aware of their options, their possibilities, and expand their horizons. I educate them, I empower them, I show them where to find good answers. If I don't know, I tell them. I encourage meditation and exercise, I teach them tools for anxiety management. I can lead them to spring water, and I can hand them a nice cup to drink it from. I just can't drink it for them.
The irony of the accusations of the MD world against us as exploiters and charlatans is that we have not brokered deals with Medicare and the health insurance industry, the pharmaceutical industry, and the hospital system to keep giving us an endless supply of patients who rarely get better and are almost never taken off their meds. If I was an MD specializing in diabetes or pain management, I'd be set for life. Instead, I educate my patients about the very specific measures they can take to ultimately reduce their need for medication. In my care, I see blood pressures normalize, blood sugars normalize, menstrual cycles normalize, mood disorders normalize, autoimmune diseases ease up, IBS tone down, allergies disappear, by applying our simplistic tenets: physician as teacher, treat the whole person, prevention, treat the cause and the healing power of nature. (I know them in latin as well, but you wrote them in English). The last one is the most signficant and most often misunderstood. It is in the nature of all living things to heal and grow and be healthy if they are given what they need, have removed what isn't needed, and their vital force supported to make the change in direction. That isn't rocket science. But it might even involve a sitz bath.
"Naturopathy is a bizarre, incoherent mixture of fact, fantasy and quackery." That's some powerful stuff to say about something you still don't understand. Our national association is meeting in Phoenix this August for our annual professional convention. You may not recognize us as physicians, because for the most part we look slimmer, healthier, happier and younger than our allopathic counterparts. We are probably going to be laughing and singing at times, while we eat our nutritionally balanced lunches with greens and whole grains, and talk about the various strains of enterococci that need to be treated with different herbs, probiotics and fibers.
Remember, in life, it is not just what you but why you do it. If you don't have a foundational philosophy in your heart, you have nothing to guide your wisdom or keep you on track. Your philosphy is scientism. Unfortunately, that can get in the way of seeing what is actually in front of you. If you don't think aromatherapy is useful, great. But if you don't understand that essential oils have a a strong interaction with our limbic, immune, endocrine and nervous system, you would just be uninformed. You are right, a lot of the time the explanations sound weak and hokey. I don't need to explain to someone why I would select lavender over clary sage, just like you don't have to explain to someone why you choose acetominophen over ibuprofen. I do that, though, because most people don't know the difference and it is important. What I usually prescribe has little chance of sending someone to the ER.
"Naturopaths choose from a smorgasbord of implausible, pseudoscientific, untested, disproven, unethical and dangerous treatment methods, including...." Wow. If you were talking about me in particular, I would sue you for slander. All doctors use methods that meet several of the above criteria at some point in their career. How many people did you give Vioxx or Bextra? Avandia? Prempro? How many patients did you educate to take their health into their own hands as much as possible, to be their own first partner in primary care? Your criteria for untested, disproven and pseudoscientific are probably related to the "gold standard" of double blind, placebo controlled trials that are almost entirely appropriate only for pharmaceutical drugs and surgeries. You can't give a sham massage- just a bad one. It's unethical to give a sham enema. I have a pretty good rule of thumb, when it comes to my outrageous personal health plans like better sleep habits, cleaned up diet- if it is way too difficult for you to manage, let's try something else. We have options. If it makes you feel sick or gives you a rash, let's stop doing it. I know, that falls into personal anecdote, but it also builds trust. My patients know I am listening to them. I don't believe in miracle cures. I do believe patients have the sovereignty to decide what will be the best way to live their lives. It may not provide the outcome desired, but they should know what their options are. Not be treated like children who are too foolish, too gullible, too naive to know they are being bamboozled.
My sister almost died at the hands of several trusted physicians who made repeated, egregious errors. She has now created a national campaign for health awareness and prevention, and is an internationally recognized speaker for her cause. Does she shun the whole MD world? No, but she balances the two with that which is necessarily livesaving and that which helps her feel better in her actual body as an actual person- not just a patient. Cranio sacral therapy and acupuncture are fantastic for pain management by the way.
Every week of my job, I am exhilarated and honored to do the work I do, and be in my profession. Every week I am greeted with tears of frustration by patients who have met years of little to no help from their regular doctor, or they have run out of medical options. Every week, I am thanked, for taking the time to really talk to them about what they needed to "get" so that they know why I suggest something, not just do as I say. Every week, I am faced with the sorrow of how many millions of Americans are being butchered by our health care system. If you don't know any of them, start reading some of the other bloggers here at OS. They will let you know how they have been utterly failed by "real doctors". I am a doctor, and I am a physician. There is art with this science. I make it fun and spiritual to boot, because people are more than the sum of their symptoms and body parts and labs.
That's the whole point of health, isn't it?
P.S. You aren't related to Dr Amy Tuteur, are you? She doesn't think it makes a difference if patients eat vegetables and fruits. She's a skeptic too.