Article on NDs being compared to DOs...
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Interesting article. The whole article goes back and forth but this part is telling:
"When the legislation was signed into law, the president of Oregon's naturopathic medical school proclaimed that NDs will soon be fully licensed physicians. "Oregon's naturopathic physicians, educated and clinically trained as primary care physicians, will soon be in a position in which they can put their full scope of practice to use at a time when the demand for low-cost preventive health care is highest," David J. Schleich, PhD, the president of the National College of Natural Medicine, stated in a news release."
"When the legislation was signed into law, the president of Oregon's naturopathic medical school proclaimed that NDs will soon be fully licensed physicians. "Oregon's naturopathic physicians, educated and clinically trained as primary care physicians, will soon be in a position in which they can put their full scope of practice to use at a time when the demand for low-cost preventive health care is highest," David J. Schleich, PhD, the president of the National College of Natural Medicine, stated in a news release."
DOs did this, what, 50 years ago?
do NDs even have core rotations? I know they're 4 year programs but giving them rights to prescribe medication? do they even have the experience and training to do this?
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There are only 5 ND schools in the US, and they're small, I believe. So, I don't know how much help they'll be in the Primary care department, unless they all go into it. They better get their own damn residencies, though, lol.
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Oregon is one of the most liberal states when it comes to health practitioners. They were the ones a few years ago who did (or wanted to) give script rights to Psychologists and the DO/MD psychs threw a fit, they've pushed hard for NPs, etc.
Altogether, the ND simply isn't a clinical degree on the level of a DO/MD. If you look at the curriculum, it simply doesn't offer a true medical education that would make someone a proficient primary care provider. However, this hasn't stopped any other group who thinks they should have full practice rights, be considered primary care providers, etc, in the past, so I'm sure you'll hear a lot from their lobbying groups claiming they are just as good ... but hollistic and kewl too.
Welcome to the future of America ... everybody wants something without putting in the work and sacrifice and everyone is CONVINCED they are entitled to something they are not. You think you should be able to take care of patients without attending medical school, completing a residency, and becoming certified by the medical boards??? Oh, well if you think it's 'unfair' and that the DO/MDs are holding you back because of the evil moniez ... then why not??? What's really at stake here - patient safety? Throw it to the wind!!!
NDs can offer some form of COMPLEMENTARY OR ALTERNATIVE treatment to medicine ... but not medicine itself. If you want to supplement care with CAM - great ... you're probably helping to put some NDs kid through college. However, don't spit in the face of science, research, and common sense and tell me that herbologists should have the rights and privileges of DO/MD physicians and surgeons. It's nuts.
However, I wouldn't really 'worry' about this threat, because it'll follow the same course as everything else (minus maybe the DNP/NP situation) -> CAM-esque group is convinced they can provide primary care and believe the DO/MDs are holding them back -> they lobby, bitch, and moan about it -> hang shingles calling themselves 'primary care providers' -> they still aren't able to make a dent in any real doc's practice or get any sort of legit privileges or insurance reimbursement.
In the end ... it's patient safety and transparency that suffers.
Altogether, the ND simply isn't a clinical degree on the level of a DO/MD. If you look at the curriculum, it simply doesn't offer a true medical education that would make someone a proficient primary care provider. However, this hasn't stopped any other group who thinks they should have full practice rights, be considered primary care providers, etc, in the past, so I'm sure you'll hear a lot from their lobbying groups claiming they are just as good ... but hollistic and kewl too.
Welcome to the future of America ... everybody wants something without putting in the work and sacrifice and everyone is CONVINCED they are entitled to something they are not. You think you should be able to take care of patients without attending medical school, completing a residency, and becoming certified by the medical boards??? Oh, well if you think it's 'unfair' and that the DO/MDs are holding you back because of the evil moniez ... then why not??? What's really at stake here - patient safety? Throw it to the wind!!!
NDs can offer some form of COMPLEMENTARY OR ALTERNATIVE treatment to medicine ... but not medicine itself. If you want to supplement care with CAM - great ... you're probably helping to put some NDs kid through college. However, don't spit in the face of science, research, and common sense and tell me that herbologists should have the rights and privileges of DO/MD physicians and surgeons. It's nuts.
However, I wouldn't really 'worry' about this threat, because it'll follow the same course as everything else (minus maybe the DNP/NP situation) -> CAM-esque group is convinced they can provide primary care and believe the DO/MDs are holding them back -> they lobby, bitch, and moan about it -> hang shingles calling themselves 'primary care providers' -> they still aren't able to make a dent in any real doc's practice or get any sort of legit privileges or insurance reimbursement.
In the end ... it's patient safety and transparency that suffers.
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I admittedly don't know much about naturopathy, but it seems that most 'alternative' therapies seem to thrive off of society's underlying fear and distrust of science (the same fear that causes anti-evolution-in-schools movements, anti-vaccination campaigns.) Isn't it rather hypocritical that a profession whose existance is based on such animosity towards science should want to prescribe drugs?
And no one needs to point out the origins of osteopathy as being the same. People within the profession broke with Dr. Still's purist philosophy even during his lifetime.
And no one needs to point out the origins of osteopathy as being the same. People within the profession broke with Dr. Still's purist philosophy even during his lifetime.
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I love the quote "What you cant accomplish through education; you accomplish through legislation."
Off shoot of that quote mentioned in the article...but oh so true!
Off shoot of that quote mentioned in the article...but oh so true!
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Lol. ND's being able to prescribe prescription medications would be the most ironic, backwards thing I have ever heard of.
I have a hard time believing any hospital or bona-fide clinic would actually hire an ND as a PCP. They would remain on the edge of medicine but with a higher likelihood of harming their patients by trying to manage diseases that they haven't been taught about, and utilizing medications that they do not have an adequate understanding of.
I have a hard time believing any hospital or bona-fide clinic would actually hire an ND as a PCP. They would remain on the edge of medicine but with a higher likelihood of harming their patients by trying to manage diseases that they haven't been taught about, and utilizing medications that they do not have an adequate understanding of.
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Along with DoktorB, I don't understand why they'd want full prescriptive rights. It would seemingly be contrary to their philosophy regarding pharmaceuticals.
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I find this disturbing, and here's why:
Here in America, we've developed a culture of entitlement, and this is yet another manifestation. These people (meaning NDs) don't practice medicine in any sense of the word.
The ONLY reason that DO's gained license and autonomy in the US was because they were willing to adopt a traditional curriculum and training as part of their education. What's more, there's plenty of data out there indicating that the patient outcomes (MD vs. DO) are the same.
DOs learn the same anatomy, medical microbiology, and biochemistry as pretty much any other medical student. Furthermore, years upon years of our lives are spent working closely with patients in real-life clinical settings (again, just like any medical student), and it is OUTRAGEOUS that someone who shills homeopathic snake oil can lay claim to the same credentials.
The most perturbing part of all this is the fact that there is no significant evidence suggesting that many of the so-called homeopathic or naturopathic drugs work at all. Labeling something as "alternative" or "complementary" may sound cool in accordance with the current fuss over new-agey bull****, but many of these people forget that herbal or natural remedies that actually WORK are called "drugs", and many of them need a doctors prescription.
As a country I think we've lost our minds. I'm sympathetic towards RNs and NPs who want expanded practice rights, but guess what? Those people have plenty of clinical experience and training and statistically, the outcomes are very similar! However, giving in to these modern-day quacks who think ginko and chamomile are going to get rid of your bronchitis is dangerous and insane.
/end rant
Here in America, we've developed a culture of entitlement, and this is yet another manifestation. These people (meaning NDs) don't practice medicine in any sense of the word.
The ONLY reason that DO's gained license and autonomy in the US was because they were willing to adopt a traditional curriculum and training as part of their education. What's more, there's plenty of data out there indicating that the patient outcomes (MD vs. DO) are the same.
DOs learn the same anatomy, medical microbiology, and biochemistry as pretty much any other medical student. Furthermore, years upon years of our lives are spent working closely with patients in real-life clinical settings (again, just like any medical student), and it is OUTRAGEOUS that someone who shills homeopathic snake oil can lay claim to the same credentials.
The most perturbing part of all this is the fact that there is no significant evidence suggesting that many of the so-called homeopathic or naturopathic drugs work at all. Labeling something as "alternative" or "complementary" may sound cool in accordance with the current fuss over new-agey bull****, but many of these people forget that herbal or natural remedies that actually WORK are called "drugs", and many of them need a doctors prescription.
As a country I think we've lost our minds. I'm sympathetic towards RNs and NPs who want expanded practice rights, but guess what? Those people have plenty of clinical experience and training and statistically, the outcomes are very similar! However, giving in to these modern-day quacks who think ginko and chamomile are going to get rid of your bronchitis is dangerous and insane.
/end rant
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I completely agree with everything else you've said ... but don't give the NPs any sympathy. They believe you're an arrogant, money grubbing, over trained, bully and believe they can perform your job better than you without attending medical school or undergoing residency training. Don't be fooled.
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I've heard it said that NDs should not handle serious medical cases.
I don't think they should handle ANY medical cases, period. Their belief system is almost by definition centered around therapies that haven't been proven to work. Anything alternative or "natural" (whatever that means) is probably fair game to them. Not to mention that they often implicitly, if not directly, attack science-based medicine, opposing proven measures such as vaccines.
Honestly, what does a naturopath have to offer anyone? Lifestyle advice? You can get that from a PCP or an RD. Herbs? That's an minefield. Homeopathy? Magic water.
They don't have the training, skills, or knowledge to be any real use to anyone. They're a waste of money and allowing them to be licensed PCPs is just going to get people hurt or killed.
I don't think they should handle ANY medical cases, period. Their belief system is almost by definition centered around therapies that haven't been proven to work. Anything alternative or "natural" (whatever that means) is probably fair game to them. Not to mention that they often implicitly, if not directly, attack science-based medicine, opposing proven measures such as vaccines.
Honestly, what does a naturopath have to offer anyone? Lifestyle advice? You can get that from a PCP or an RD. Herbs? That's an minefield. Homeopathy? Magic water.
They don't have the training, skills, or knowledge to be any real use to anyone. They're a waste of money and allowing them to be licensed PCPs is just going to get people hurt or killed.
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Haha, I wouldn't go quite this far. There are plenty of level headed ND's out there that do their research (and know their bounds, I might add). I check up on my family members that go to see ND's, and have been pleasantly surprised with their recommendations. They have mostly given great dietary advice, prescribed relatively harmless herbs, and used evidence based practices on any treatments that might have physiologic effects on the body. They have also been really good about knowing when to refer to a PCP and/or specialist when it is out of their expertise (which has happened several times).
It is when they try to take on too much that it becomes worrisome, which definitely happens. It is also on the patient to know the limits to which they can trust their ND with their healthcare management, and when it is time to see a physician.
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This platitude has always struck me as potentially explainable through the availability heuristic rather than some quantitative estimation of entitlement levels over the decades.
Well with everyone claiming theyre just as good as doctors how are patients supposed to know?
This onus should be on the practitioner but if they are trying to expand their rights they are less likely to do this properly.
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There ARE some principles held by NDs that are good. Things like focusing on nutrition, rehab, massage, accupuncture, lifestyle modifications, etc. BEFORE presribing meds. My problem has been that, as a whole, the only people talking about how great and equal they are is....them. They churn out lots of very nice propaganda videos for their schools. They also title a lot of their classes the same as medical schools and assign credit hours to make it look like they must learn so much more...or just have multiple semesters more of a course for whatever reason.
Like many things, many of them and their supporters only hear what they want to hear. You try to present reasonable evidence and you get the whole fingers in the ears and yelling "LALALALALALALALA" while you talk or they simply cherry pick examples. I don't think we should prescribe as much as we do for every problem, nor do I care if a patient wants to try it. If it works for them then great. I do care about the willful ignorance and overconfidence in one's abilities.
Like many things, many of them and their supporters only hear what they want to hear. You try to present reasonable evidence and you get the whole fingers in the ears and yelling "LALALALALALALALA" while you talk or they simply cherry pick examples. I don't think we should prescribe as much as we do for every problem, nor do I care if a patient wants to try it. If it works for them then great. I do care about the willful ignorance and overconfidence in one's abilities.
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I definitely understand what you're saying ... but trying to balance out the over prescribing for relatively small issues is counteracted by the inability to catch, diagnose, and prescribe/treat for serious issues.
For example ... I once saw an ND who, among their list of services, claimed to treat cancer patients. Not offer CAM in adjunct with chemo and surgery, but TREAT cancer patients. Frankly, this type of attitude + the inability to offer sound scientific treatments for serious diseases and the hesitation to refer to professionals who can (the evil DO/MDs) is just blatantly dangerous.
If patients want to research their options and integrate CAM ... no problem. If patients are lured into believing NDs are 'full physicians' who can do everything the DO/MD can + have a 'superior' ability to keep people off the big, bad pharma drugs ... big problem. Frankly, that's what NDs are trying to do.
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So true....
My two cents. I used to live in Oregon and the medical laws there are extremely liberal. I have been treated by NDs, Acupuncturists and MDs.
Personally I did not care for the way NDs practice. And I do not see how they could be lisc as full physicians.
Now I have an MD and an Acupuncturist that I see regularly. I feel that being treated by both of them offers me a well rounded, comprehensive wellness program.
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In Seattle on the bus towards the mall there's an ND's office there. It looked like one of those 1-800 psychic businesses, because it was a small-house between two houses.
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This reminds me of the chiropractor around here who advertises that he cures ADHD.
It all goes back to the dear of science. It is the same reason people insist that vaccines are autism waiting to happen, etc...
Another flaw I see with some of these CAM "modalities" is that they emphasise continued treatment as a an ongoing thing, just to maintain optimum health... i.e. 'come have your weekly adjustment.' Thus these professions turn into profit mills.
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You see, I was considering becoming a ND before I considered that for the same level of undergraduate work (okay, plus a MCAT), I could become a MD or a DO. But I was really turned off by the ND programme because they embrace homeopathy. So much so that their national board exam tests on it.
Part II: Core Clinical Science Examination - The single, integrated examination consists of 90-100 case clusters (400 items) that cover the topics of diagnosis (physical, clinical, and lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, counseling, behavioral medicine, health psychology, emergency medicine, medical procedures, public health, pharmacology, and research.
Fortunately, here in the State of Colorado, Naturopaths haven't been granted licensure yet. But my Anatomy teacher, who is a Bastyr alumni, still practices but under his Accupuncture licensure.
Part II: Core Clinical Science Examination - The single, integrated examination consists of 90-100 case clusters (400 items) that cover the topics of diagnosis (physical, clinical, and lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, counseling, behavioral medicine, health psychology, emergency medicine, medical procedures, public health, pharmacology, and research.
Not to my knowledge. In the states where they do have the right to prescribe, their ability to prescribe is somewhat limited - but not by much. Your run of the mill ND can still probably write scripts for Vicodin and Percocet.
Yes, they are quite small but there are 6 schools and those schools are NCNM (the one in Oregon), Bastyr (Washington), SCNM (Arizona), NUHS (Illinois) and U of Bridgeport (Connecticut). And as it was presented to me, Naturopathic Medicine is exclusively primary care - there are no specialties and residency opportunities are limited. For certain, there is no central matching system for homeopaths, whereas we have a number of them (NRMP, CaRMS, AOA, etc).
Yes, I was attracted to Naturopathic Medicine when I was going to a very liberal arts Buddhist College up in Boulder and the Anatomy teacher (at the time, I was doing a Naturopathic track) was a ND. I queried him on why Naturopaths embrace homeopathy and he claimed that there was such a thing as the "Nocebo effect".
Fortunately, here in the State of Colorado, Naturopaths haven't been granted licensure yet. But my Anatomy teacher, who is a Bastyr alumni, still practices but under his Accupuncture licensure.
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Source PLEASE.
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When the real naturopathic doctors start focusing their attention on the vast majority of naturopaths who went to unaccredited schools and/or have little to no training in medicine or naturopathy (a.k.a the quacks), then we can talk. Until then, this is just another case of a group putting patient safety at risk so they can get more power.
If someone started a physician practice and didn't have an accredited degree, the AMA/AOA would be on their ass. That's not the case with naturopaths.
If someone started a physician practice and didn't have an accredited degree, the AMA/AOA would be on their ass. That's not the case with naturopaths.
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In Oregon, Hydrocodone and Oxycodone are on the ND Formulary code: http://www.oregon.gov/OBNM/DEAPerscribing.shtml
Washington's code is a little less specific but the above can be assumed: http://apps.leg.wa.gov/WAC/default.aspx?cite=246-836-210
Now, since I don't want to spend all night looking up the rest of the state statutes I present these two, for now. (FYI: In the interest of fairness, I couldn't find Alaska's code on Naturopathic Physicians and California and Arizona restrict NDs to only natural substances, as per their codes)
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Wow. I didn't look into the specifics too much, but a. that's horrendously hypocritical, and b. shocking.
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I'm curious, how is it hypocritical (I'm not doubting you, I tentatively believe you - I just want to know why).
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I'm really waiting for the day some field tries to get involved in surgery....
I know NDs and I know ND students. I lived next to an ND school down in Arizona (it was a converted motel or a pre-school I believe). There is no comparison in the level of training or intellectual capacity of the average ND vs DO/MD.
None.
I know NDs and I know ND students. I lived next to an ND school down in Arizona (it was a converted motel or a pre-school I believe). There is no comparison in the level of training or intellectual capacity of the average ND vs DO/MD.
None.
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Optometry?
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I imagine this has been beat to death but they really need to just change all DO to MD (Osteopathic MD). DO doesn't even make sense anymore.
If not then they should have to change MDs to DA. Doctor of Allopathy...lulz.
Being a little misunderstood by the misinformed public is one thing, but comparisons to NDs is too much.
If not then they should have to change MDs to DA. Doctor of Allopathy...lulz.
Being a little misunderstood by the misinformed public is one thing, but comparisons to NDs is too much.
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Yea...pretty scary. Especially since Wash and Oregon allow prescription rights. I had no clue about that.
I've had classmates from undergrad who are extremely capable go the ND route. It was kind of disappointing to see them take that path when thy had the capacity to obtain an MD/DO. It still baffles me to this day why one would go that route over becoming a fully licensed physician. The fact that they teach homeopathy (as someone was talking about before) was enough for me to stay away...but alas, I did learn cranial OMM this year 😉
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Might as well have just said dentistry... I'm sure you realize I'm referring to these upstart degrees.
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There may be a few other states that do but I just mentioned those two because I knew for sure that they allowed prescription rights.
As someone who was considering the ND route, it looks pretty attractive until you start digging deeper and hit the layer of BS. Once I did that, I could never get over the fact that I would have to study homeopathy, something that they actually test on in the NPLEX and the AANP officially supports homeopathy.
Personally, I'm thankful that I found out that I could do a MD or DO programme with the same pre-med science coursework, but just a little bit harder work - both with higher grades and studying for the MCAT. I don't think that I could honestly do a ND now.
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Will never happen. The AOA is so hellbent on keeping up this insane osteopathic identity...even though most ost/eopathic students and physicians dont even really identify with it anymore. Look at the top brass at the AOA. FPs and NMM specialists. Nothing like that will happen until the AOA top is infiltrated by the "real face" of DOs....and not the 1920s face of DOs.
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It doesn't make sense, and it just confuses the people who need doctors.
The more I think about it the more stupid it becomes.
It would be like calling PhD something different because he did yoga, or something like that.
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I agree with you...but it wont happen. Maybe once this generation gets into practice but not until then. But then again...every DO class has a handful of these "DO maniacs" who you can tell would love to repopulate the AOA.
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NDs are natural healers and (supposedly) shun big pharma drugs. They should treat with herbs and teas, not morphine and pain killers. It's 100% against their entire mantra/philosophy ... hence, hypocritical.
Just following the money like everyone else.
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To be fair, osteopathy was the same way. Both the ND and DO communities have gone through a lot of change in the past century. One took Flexner to heart, and the other decided standardized edumacation wasn't important enough, but both stopped shunning all drugs.
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I'm not sure it would be best to go out and judge NDs as being uneducated and anti-prescription yahoos who are looking to make a more money. Sure they provide an alternative method of treatment through herbal remedies and diet, but their schooling in pharmocology is actually pretty extensive. One of my former lab colleagues who initially was going to apply to MD school with a 3.5gpa and 32 MCAT decided to go to the Portland ND school instead. He tells me its pretty intense schooling. He had to go through anatomy, biochemistry, and pharmocology his first couple of years just like many other DO/MD medstudents have to go through. He even introduced me to one of his classmates who already has an MD/MPH degree and was looking to expand his way of treatment by getting an ND.
The moral of the story is that I would just be very cautious before you judge a degree before you actually meet someone with that background and learn what it actually is all about.
The moral of the story is that I would just be very cautious before you judge a degree before you actually meet someone with that background and learn what it actually is all about.
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On ND wanting to be licensed PCPs:
If it walks, talks, and acts like a duck.....
quack, quack. 😡
If it walks, talks, and acts like a duck.....
quack, quack. 😡
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Yes ... Osteopathy was the same - 90 years ago. During that time, DOs have evolved to accept evidence based guidelines and have earned the right (via education and training) to prescribe these drugs in 2011. Fully licensed physician with a supposed philosophy of a 'holistic' approach that CAME from drug shunning roots (back when drugs killed more people than they saved) in the late 19th centuries really doesn't have much relevance to the discussion of a group in 2011 that still teaches courses in homeopathy, herbology, etc, and states (in 2011) that they heal without the unnatural drugs.
Like I said before, saying they now want to be considered comprehensive physicians, prescribe, etc, is not only laughable (I'm sure they had the chance to do this or conform to some system like this way back in the day like DOs), it's just another perfect example of health practitioners wanting to expand their scope without appropriate training.
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This is a classic diversion ...
just because I call a course 'anatomy,' 'biochemistry,' etc, doesn't mean that it holds a candle to real medical school anatomy, biochem, physio, etc.
Hell, community colleges offer courses in anatomy, biochem, and physiology ... am I supposed to believe that these, because of similar titles, offer the same level of understanding/detail as my medical school courses?
Furthermore, since I have 0 faith in the board that oversees curriculum standards at the ND schools, I cannot assume that the quality of these courses (with similar titles) is anywhere near the level of DO curriculum.
Also, just to counter your anecdote with another (to demonstrate that the 3.5/32; MD/MPH getting a ND doesn't hold much weight) I once spoke with an ND who went back, got his DO, and was now in residency ... and his explanation of the curriculum differences, what he knew before starting med school, what he understood after, etc, really reinforced my points that the level of education simply isn't on par with DO/MD curriculum, which should worry people when it comes to a push for expanded privileges, rights, etc.
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I've always thought that the AOA board was repopulated through mitosis...
Ah, gotcha.
Considering the fact that they embrace homeopathy and shun vaccines, I think it's pretty safe to shun the Naturopaths. Especially the ones that populate the AANP.
They have NO specialties (other than primary care), they have NO residencies required and they embrace pseudoscience. Why the hell would they want to be considered comprehensive physicians? It's like my electrologist being considered a comprehensive physician. Sure, she does a great job at killing what remains of my facial hair but I don't want her prescribing me drugs... except painkillers. Electrolysis can be brutal.
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Why do Chiropractors want to be considered primary care providers? Why do nurses want to call themselves doctors and practice dermatology, cardiology, family medicine, anesthesia, etc? Why do Optometrists want to perform eye surgeries?
1. Money
2. The mindset that physicians are evil, have a chokehold on health care, and that they are qualified to do everything that the docs can without any additional training.
Add this to an effective lobbying group, smart PR, and an endless supply of slick politicians, and you have the current state of things with NDs, DCs, DNPs, CRNAS, E.T.C.
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I completely agree with that. It was your earlier quote I was disagreeing with ...
"NDs are natural healers and (supposedly) shun big pharma drugs. They should treat with herbs and teas, not morphine and pain killers. It's 100% against their entire mantra/philosophy ... hence, hypocritical"
Saying naturopaths are natural healers who shun big pharma is like saying osteopaths are bone fetishists who shun big pharma or allopaths are anti vaccination quacks who are in bed with big pharma. Sure there is the naturalistic aspect to the certified ND curriculum, just as there is OMM in the DO curriculum, but both professions have evolved to a point where they embrace pharma in some circumstances. Whether NDs are knowledgeable enough to safely prescribe drugs, I have no idea (and I assume they are not), but its not hypocritical. It's just an evolving philosophy.
I should clarify that I am referring to NDs graduating from accredited schools and programs, and not those quacks you see on Penn and Teller's Bull!@#$.
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I think it would also give them a bit more respectability that frankly, they didn't earn. DCs should stick with Chiropractic practice and stay out of primary care.
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I think my point is that from what I've seen ... NDs haven't really evolved with any regard besides wanting more rights. They still express the 'all natural' philosophy, which can't still be said of modern DO schools. DO schools evolved to the point they are at because they saw what was effective, adjusted the education, and did what was best for patients.
NDs, from what I've seen, just want expansion ... and with this comes script rights, but I see no other 'evolution' within the curriculum whatsoever.
I get what you're saying, I just disagree that NDs have evolved in the same manner ... they just want more rights.
