first and foremost there are two types of NDs, ones who get a 2 year online correspondence degree and another group who attend a 4 year program set up similar to the traditional medical school model (2 years of didactics, 2 years of clinicals) Actually, if you look at the historical background the first 4 year "medical school" in the United States was a Naturopathic School.
The NDs who attend 4 years of education can also proceed into a one year internship. It is this group of NDs who by law in 17 states are classified as primary care physicians, can prescribe medications, order labs, diagnose and in some states bill insurance.
Its a confusing issue and doesnt make sense, but its important to know who you're bashing and who you're calling "not a physician" - since state and government law actually dictates otherwise in many circumstances. They technically are your colleagues (this was the same issue between MDs and DOs in the 40s-50s until the vietnam war era bridged the gap between the two)
Actually, I did know about the differences between the two NDs, but thank you for assuming my ignorance on the subject. I also know the distinction is functionally meaningless when you review the core curriculum of the 4 year degree programs (emphasis mine):
"In the world of real medicine, we have two kinds of primary care physicians: internists and family practitioners. They have four years of medical school and then a three year residency, taking care of patients under the guidance of senior physicians, to learn the basics of their job before going into practice
. Most naturopaths do not have to have a residency going straight to patient care from school.
The training requirements in pharmacy, per the naturopathic board, is minimal: “ Naturopathic physicians are required to take 72 hours of pharmaceutical training as a part of their doctoral degree. Additionally, they must also have 1,500 hours of clinical training. Naturopathic physicians are required to take 25 hours of continuing education course work annually, five of which must be in pharmacology.”
Nine days of pharmacy training in school in school. 1500 hours is 35 forty hour weeks
. A little over half a year of clinical experience. That is the background of naturopaths who will give medications. For comparison, in med school we spent 4 hours a day for the three months of the second year in pharmacology and I had five years of clinical experience just for internal medicine.
At our local natuopathic school they get 72 hours of pharmacology education, and twice (144 hours) as much training in homeopathy. The have the opportunity to do electives to broaden their knowledge: 144 hours in homeopathy, 36 hours in qi gong, 26 hours in Aruyveda, 24 hours in energy work and 12 hours in colonics. But no electives in pharmacology. A good foundation upon which to prescribe medications."
Source
Even if NDs in all 17 states had to complete a 1 year fellowship, do you think so little of your PCP colleagues and their extensive training as to consider the two equivalent? Furthermore, *how do you feel about the frankly adversarial stance NDs have on vaccination, or the evidence that low vaccine uptake is correlated with naturopathic care?
There are quite a few CAM therapies that are much more proven and scientifically based than many of the procedures/medications I use on a consistent basis in the hospital (probiotics come to mind)
NCCAM has been pushing that line for ages, but the fact of the matter is if medicine works, it stands the test of scientific rigor and is gradually incorporated into treatment protocols, subject of course to amendment when new data and therapies emerge. That’s medical science. How has homeopathy, acupuncture, humoral medicine and ayurveda evolved in response to findings in the literature, particularly the negative results found in well designed, properly powered clinical trials?
Also, I wouldn’t hang your hat on probiotics just yet; beyond treating diarrhea the jury is still out and much of the evidence is extremely poor for the manipulation of microbiota as a therapy for anything else.
not to mention that OMM has some of the poorest research (show me good research on fascia release, lymphatic drainage, cranial manipualtion, counterstrain, etc) yet its the foundation of our profession.
Can’t fault you there, but why is the appropriate response to finding a marginal evidence base for one modality to pay credence to any other whackaloon modality out there? Shall we arrange a lecture by a reiki master or a light therapist next?
I'm sure you as medical students are just too busy to actually really read the good research out there. Which is a sad state. You should in reality be more up to date than your attendings/professors as to the new research on multiple modalities.
I admit that as a pre-med, my familiarity with the medical literature is not as UpToDate as I would hope, but I do read voraciously about CAM. Consequently I am also aware of the horrendous spin that permeates CAM literature (though spin is by no means exclusive to alt med research), meaning I am reading beyond the abstracts and discussion sections of the articles you might cite in support of these allegedly efficacious naturopathic remedies to find horrendously designed, underpowered trials that are over-interpreted. Case in point, the recent TACT trial was appallingly negative, finding no benefit to chelation therapy on any of the hard, cardiac end points and only one marginal statistically significant effect after p-hacking the data to death. But to read the publications off that data set, you’d think the world of alternative medicine had just given us a therapeutic boon. But I mean, what do I know?
As a resident I am consistently discussing new treatments and modalities to my attendings, and often they change their stance and make adjustments (just recently the use of tranexamic acid has become standard with our attendings due to our group of residents pushing for its use because new research was pointing to its benefit, plus we got tired of the bloody post op dressings and pulling drains). Oh we use dakins solutions all the time in orthopedics (wasnt that a CAM therapy a previous poster bashed on???? broaden the mind)
You’re very clever for pointing out that bleach is used in surgery. Now please justify its use in treating autism or for scouring breast-masses as a “natural” therapy, since these are both things your esteemed colleagues do to patients in exchange for money.
Yes I think it should be required to learn about CAM therapy, its positive and negative effects (as was discussed in a previous post about the metastatic breast cancer).
And yet, you ridicule your colleague’s disdain for the use of CAM under the guidance of an ND by trying to minimize the audacity of any health care provider using bleach to treat cancer. How much time should be spent outlining the positive aspects of CAM, and how much time should go to the victims of CAM?
Often times what was once thought was CAM is now the preferred treament with supportable data, AND we need to be understanding to our patients who are misinformed in many situations. Calling them stupid (as one premed poster did about steve jobs - have you ever seen a whipple?) won't win them over. We need to respect their choice, inform them out of compassion of their mistakes and give better recommendations, often meeting them in the middle.
Again, please show me where CAM has changed its course in the face of new evidence, as medicine is wont to do. While we can respect the choices of patients, we students are allowed to and should be encouraged to question dubious practices by the institutions allegedly preparing us to think critically, assess evidence and provide the best guidance to our patients. Listening to a mandatory lecture on magic by a true believer will not help this process in anyway.
And to be completely fair, there isn’t much evidence that Steve Jobs would have been better served by conventional medicine either. The difference being most honest physicians won’t lie about the limitations of their practice, where a naturopath will attempt to bilk you as long as you live by recommending a variety of made up nutritional aids and bizarre diets, electrotherapy, homeopathy, colonics, and positive thinking. If you don’t believe in empirical evidence, what’s the harm in trying everything you “know” to “save” someone?
Lastly - as an informed medical student that you all seem to be, throwing the word qwackery and qwack around probably isnt the best use of vernacular. The word quack was applied in the early 1900s to the physicians who used quicksilver (ie mercury) for their treatments. These were the founding fathers of pharmacology and modern medicine. Quite ironic.
All teaching is biased, relax, its not the end of the world. There are more things to be upset about in medical school - like rising tuition prices - than a 2 hour lecture from an ND. Bring the hate.
OED says…
1.
a.A person who dishonestly claims to have medical or surgical skill, or who advertises false or fake remedies; a medical impostor. Cf.
charlatann.2.
1638 F. Quarles
Hieroglyphikesiv. 17 Quack, leave thy trade; Thy Dealings are not right, Thou tak'st our weighty gold, to give us light.
No, I’d say we’re using the word perfectly correctly, and its use to denote frauds predates your estimation substantially. Physicians of yore who could not benefit from the advances of modern science were very much quacks. The difference, of course, being that modern physicians stopped using quicksilver as a first line therapy, where NDs are still cooking toxic tinctures or diluting substances to nothing according to recipes unchanged for centuries. All I can say is thank god for the Flexner Report.