Would you consult with an ND (naturopath)?

[facetguy]

I wouldn't consult with her. The patient could do whatever he/she wanted, but I wouldn't waste my time.

So much for doing what's best for the patient. Let's instead do what's best for Goose.

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Members don't see this ad.

 

[rickthetwinkie]

...We don't need to be reckless with care to keep an open mind.

Eh hem, homeopathy?

And, as I mentioned earlier, other forms of non-mainstream treatments can be very helpful for many of your patients, whether you currently believe they will or not.

Like what? Nutrition counseling is not "alternative". A well-trained physician can provide nutrition counseling or consult a R.D. without the excess baggage of woo attached. What forms of alternative therapy do you find promising? Reiki? Ayurvedic medicine? Acupuncture?

 

[SocialistMD]

The primary physician always holds the trump card, particularly in an inpatient (hospital) setting. You could consult cardiology for an arrhythmia and then completely ignore their recommendations. There is no harm in consulting an ND, as they will undoubtedly know something you don't that may make your patient better (not necessarily a cure, but make them feel better, improve their mental status, etc...). If you don't like what they say, ignore their recs. It is that simple.

Maxprime- Nutritionists can be some of the most invaluable people, particularly in the ICU. There are many different forms of tube feeds that benefit certain populations. They know all of these and they know which is best suited for each patient. They know the number of calories in each, the percent from carbs, protein and fats, and the electrolytes in each. Could most people get by on jevity? Probably, but why not optimize your patient's nutrition. They are a great resource for patients who are malnourished, they will recognize certain deficiencies that you won't and most of them enjoy teaching you what they know (if you aren't too proud to learn from them).

Originally Posted by facetguy
And, as I mentioned earlier, other forms of non-mainstream treatments can be very helpful for many of your patients, whether you currently believe they will or not.

Like what?

Music therapy. Meditation (see Fight Club). Aromatherapy. Breathing therapy (Lamaze anyone?). All of these are considered "alternative" but have been shown to offer some benefit.

So, would you agree that cancer patients have no business visiting naturopaths?

Would you say that people with unresectable pancreas cancer have no business visiting a physician period? Nothing anyone can do can cure their cancer, yet medical oncologists still see them to palliate them. This palliation is the same thing that would happen with NDs.

As has been stated before, this isn't about you, it is about your patient. If your patient wants a naturopath, there is little harm that can be done, particularly if you have the final say as to what is done. Naturopaths aren't out to sabotage you and your practice, they want to help the patient, too. I don't know from where this paranoia comes, but it is kind of sad.

 

[rickthetwinkie]

The primary physician always holds the trump card, particularly in an inpatient (hospital) setting. You could consult cardiology for an arrhythmia and then completely ignore their recommendations. There is no harm in consulting an ND, as they will undoubtedly know something you don't that may make your patient better (not necessarily a cure, but make them feel better, improve their mental status, etc...). If you don't like what they say, ignore their recs. It is that simple.

NDs are not qualified to be primary care physicians. I would consider talking with the ND much like I would consult a family member or friend of the patient considering the ND would have information I didn't, however, conferring with them about medical therapy? No. I do not grant NDs the legitimacy they desire nor do I feel that they are qualified. There is too much woo baggage involved.

Music therapy. Meditation (see Fight Club). Aromatherapy. Breathing therapy (Lamaze anyone?). All of these are considered "alternative" but have been shown to offer some benefit.

Music therapy - has plausability.
Meditation - has plausability.
Aromatherapy - I looked through Cochrane reviews and found very little to recommend except for relaxation.

Would you say that people with unresectable pancreas cancer have no business visiting a physician period? Nothing anyone can do can cure their cancer, yet medical oncologists still see them to palliate them. This palliation is the same thing that would happen with NDs.

It's not like I would bar the patient from consulting the ND by their lonesome. They have every right to. However, in terms of medical therapy, I will not take their recommendations or consult them.

As has been stated before, this isn't about you, it is about your patient. If your patient wants a naturopath, there is little harm that can be done, particularly if you have the final say as to what is done. Naturopaths aren't out to sabotage you and your practice, they want to help the patient, too. I don't know from where this paranoia comes, but it is kind of sad

I'm not paranoid. However, I have ideological objections to granting "alternative" practitioners the legitimacy that academic medicine has, despite the implausability of their methods. NDs, while having supposed basic science training, are not merely "nutritionally enlightened" physicians. They are trained in many implausible and ineffective methods of treatment.

However, what the patient does is their business, and I will respect their autonomy.

 

[SocialistMD]

NDs are not qualified to be primary care physicians.

Yeah, I realize this. Neither are surgeons, radiologists, neurologists, psychiatrists, anesthesiologists or any other MD not an internist, FP or pediatrician (and sometimes OB), but you'd listen to them about medical therapy. Is it simply because they have the same degree as you, so you respect them? Would you consult a physical therapist? A dietician? A pharmacist?

I'm not paranoid. However, I have ideological objections to granting "alternative" practitioners the legitimacy that academic medicine has, despite the implausability of their methods. NDs, while having supposed basic science training, are not merely "nutritionally enlightened" physicians. They are trained in many implausible and ineffective methods of treatment.

I think this is the root of your stance; your inability to accept that someone who trained differently than what you feel is the "right way" may have something to offer will prevent your patients from getting the best possible care.

 

[-Goose-]

So much for doing what's best for the patient. Let's instead do what's best for Goose.

Lets all gather round the fire and sing koom-by-ya while we're at it. And then we could consult a therapist to see how we all really feel about it and for some group therapy. Afterwards, we'll all consult a starbucks barista and drink some lattes.

I would have no problem with the patient seeing a naturopath, a psychic, or a wizard. Like others have said, it just wouldn't waste my time with it.

 

[biocmp]

If my patient would like to seek other treatment sources, I would recommend:

1. A nutritionist- to help them eliminate/minimize anything that may increase their health risks

2. PhD trainer( I don't have a better name)- I have a friend that is getting his PhD in Nutritional Biochemistry. He is without a doubt, one of the most knowledgable people when it comes to nutrition, exercise, and previous conditions, this includes genetic predispositions, lifestyle-incurred diseases etc. He will get a lot of referrals from me later on in life.

3. A physical therapist- PTs do a lot of great work, so if they were looking at some sort of rehabilitation, this is the route I would take

I don't see the benefit of an ND, unless we are shooting for the placebo affect. It does depend on training, so I guess if my patient were wanting accupuncture or some sort of massage therapy, then I would have no reservations, but I feel that there are plenty of people who are qualified to help teach about lifestyle habits and nutrition that warrant attention/referral way before I would recommend an ND.

* let me give a disclaimer* If ND's decide to get sponsored, peer-reviewed research- and there are strong positive correlations between something they exclusively administer and patient wellness, then I will retract my previous statements. But, until then...

 

[OncoCaP]

Below are results from a pubmed search for "acupuncture randomized clinical trial." There are some top medical schools doing research in this area with NIH funding. Although there clearly is some back-alley medicine going on in the "natural medicine" world. At thes same time, there is some very respectable and effective researchers in this field as well. There are probably other studies we can look up for some of the more popular "natural" treatments as well. My PDA even has commercial software with a lookup feature for a huge number of "natural" meds so I can at least see what we know about them and what they are often used for (dosages, available research / studies, toxicities, interactions, etc.).

The way I see it many of these "natural" practicioners are filling a gap left by allopaths who in many cases are "too busy" to provide what many outside and inside the medical profession would consider compassionate / adequate care. In other cases, the alternative medicine crowd simply has something that can't be provided by allopaths with their drug company providers at a billion dollar + /yr profit (it's not worth it for our allopathic sources to provide from a financial standpoint, but it works better than anything we have). It's not that uncommon to have a new expensive allopathic med that isn't really that much more effective than an old cheap med solely to bring home the bacon for lots of shareholders and medical and drug company workers. Let's not forget that profit is a huge motivator in both the allopathic and natural medicine arenas and the most effective treatment might fit better into one or the other business models (allopathic vs alternative) for providing care, but not both.

Here is some information about the first study:

(for the first reference below)
This work was supported by NIH Grants DK065266 and DK38955, National Institutes of Health, Bethesda, Maryland.
Requests for reprints should be addressed to John N. Krieger, MD, Department of Urological Surgery, University of Washington, 1660 S. Columbian Way, Seattle, WA 98108.


The American Journal of Medicine
Volume 121, Issue 1, January 2008, Pages 79.e1-79.e7


Items 1 - 20 of 1446


Items 1 - 20 of 1446Page of 73Next
1: Related Articles, LinksLee SW, Liong ML, Yuen KH, Leong WS, Chee C, Cheah PY, Choong WP, Wu Y, Khan N, Choong WL, Yap HW, Krieger JN.

Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain.
Am J Med. 2008 Jan;121(1):79.e1-7.
PMID: 18187077 [PubMed - indexed for MEDLINE]2: Related Articles, LinksStaud R.

Mechanisms of acupuncture analgesia: effective therapy for musculoskeletal pain?
Curr Rheumatol Rep. 2007 Dec;9(6):473-81. Review.
PMID: 18177601 [PubMed - indexed for MEDLINE]3: Related Articles, LinksLin GJ, Fat u Camar a.

[Randomized and controlled observation on acupuncture and moxibustion combined with western medicine for treatment of malaria of children in Africa]
Zhongguo Zhen Jiu. 2007 Nov;27(11):859-61. Chinese.
PMID: 18085153 [PubMed - indexed for MEDLINE]4: Related Articles, LinksWu RD, Zhang HD, Lin LF.

[Observation on ear point taping and pressing therapy for treatment of primary dysmenorrhea]
Zhongguo Zhen Jiu. 2007 Nov;27(11):815-7. Chinese.
PMID: 18085144 [PubMed - indexed for MEDLINE]5: Related Articles, LinksHu ML, Zhang KX, Zhang RP.

[Observation on therapeutic effect of acupuncture at point "Xiajiquan" on muscular strength of finger after apoplexy]
Zhongguo Zhen Jiu. 2007 Nov;27(11):813-4. Chinese.
PMID: 18085143 [PubMed - indexed for MEDLINE]6: Related Articles, LinksSun YZ, Zhu PY, Zhang M, Zhang Y.

[Clinical observation on Yuanluo Tongjing needling method for treatment of mild cognitive impairment]
Zhongguo Zhen Jiu. 2007 Nov;27(11):810-2. Chinese.
PMID: 18085142 [PubMed - indexed for MEDLINE]7: Related Articles, LinksWu B, Jiang CH, Zhou QY, Chen QM, Shu Y, Li X, Lu YH.

[Treatment of residual neuralgia of herpes zoster by ear point taping and pressing therapy combined with acupoint-injection]
Zhongguo Zhen Jiu. 2007 Nov;27(11):807-9. Chinese.
PMID: 18085141 [PubMed - indexed for MEDLINE]

 

[Caboose]

I thought this might be an easy read on alternative therapies: http://www.ncbi.nlm.nih.gov/sites/e...herapy&search=Find Articles&db=pmc&cmd=search

The FDA might approve a drug for you to prescribe after a controlled study for 18 months. There are all sorts of things unscientific about putting a person on that drug for a chronic illness along with a few other pills as they need it - suddenly there are many more variables than studies can account for leaving our medicine based on an educated guess. I believe medicine is not as sound of a science as it appears.

There are 4 institutions in the US that graduate fully prepared NDs. There are also nauseating online programs that steal the title without actually licensing physicians. This confusion is because in the 1930s naturopathic medicine, which is based on the Hippocratic philosophy of "Vis Medicatrix Naturae", was stomped out as a result of politics and economic shifts due to the pharmaceutical boom after the discovery of penicillin. The oldest school in our nation is only 51 years old. ND students must pass standard premed requirements when seeking admission. The NPLEX is designed for second year medical students to prove that they have learned microbiology, biochemistry, anatomy, physiology and pathology. After 3rd and 4th year clinical training, another test assesses their qualifications. Yearly continuing education credits are also required to practice.

http://www.naturopathic.org/viewbulletin.php?id=19

With hippies getting older, you might want to know things like St. John's Wart can negate the effects of the medicine you prescribe. The scope of practice of licensed naturopathic physicians includes prescribing antibiotics, hormones and epinephrine. Be careful if you convey your contempt for the practice because your patients may just not tell you who they are seeing and what they are taking.

I think it's very difficult for physicians and patients to know who the real trained naturopathic doctors are. That should really be investigated before trusting one or throwing them out as a quack.

I have a biochemistry and medical ethics test coming in 41 hours.

Caboose.

 

[Tired]

Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain.
Am J Med. 2008 Jan;121(1):79.e1-7.
PMID: 18187077 [PubMed - indexed for MEDLINE]2: Related Articles, LinksStaud R.

They were originally going to title that paper, "The Effect of Fake Treatments on a Fake Disease", but felt that was being too honest.

 

[dilated]

The way I see it many of these "natural" practicioners are filling a gap left by allopaths who in many cases are "too busy" to provide what many outside and inside the medical profession would consider compassionate / adequate care. In other cases, the alternative medicine crowd simply has something that can't be provided by allopaths with their drug company providers at a billion dollar + /yr profit (it's not worth it for our allopathic sources to provide from a financial standpoint, but it works better than anything we have). It's not that uncommon to have a new expensive allopathic med that isn't really that much more effective than an old cheap med solely to bring home the bacon for lots of shareholders and medical and drug company workers.

Yay "natural practitioners"! Boo evil drug company capitalists!

What exactly in what you said requires ME to "consult" with this person? If they're getting their amazing caring regimens that work better than pharm products, yay them. Even if we were to take all of this propaganda as true, it still has no impact on the question of how the ND would impact what you do (besides possibly the aforementioned drug interaction list).

 

[OncoCaP]

Yay "natural practitioners"! Boo evil drug company capitalists!

What exactly in what you said requires ME to "consult" with this person? If they're getting their amazing caring regimens that work better than pharm products, yay them. Even if we were to take all of this propaganda as true, it still has no impact on the question of how the ND would impact what you do (besides possibly the aforementioned drug interaction list).

I'm certainly not requiring you to consult with an ND. I'm not entirely sure where you are coming from on that.

I thought this was surprising: http://nccam.nih.gov/news/camsurvey_fs1.htm
I didn't realize the NIH was so involved in complementary and alternative medicine. Apparently 75% of U.S. Adults have used complementary and alternative medicine at some point in their lives:

What exactly is CAM in the U.S.? Looks like it's mostly prayer, and so you'll more likely run into a pastor or priest than an ND:

 

[RockShox]

Oh the Sematics of the media. It is why we no longer talk about green-house effect because hey if we call it global warming we can confuse the public that they are one and the same.

Another idea lets use CAM instead so that we can make it appear as though medicine is split into two camps. It only takes a half a neuron to realize that this is invented bull. Someone mentioned it once and I will mention it again.

Anything that is theraputic, and ameliorates the suffering of the ill will ALWAYS be used and included in the practice of medicine. Anything that is not, is not alternative, it is illegitimate. I get tired of groups that have weak structure, little oversight, and limited scientific background trying to pit patients against physicians.

I worked in oncology and I got tired of patients refusing radiation for treatable cancers because they "heard" that someone could "naturally" cure their cancers by making them drink their own refined urine. Only later to come back to us long after the cancer had progressed to an uncurable stage. Do we not remember that Loretta Scott King died in a "holistic" center in mexico that had on its own extended its scope of practice into surgery, xray, etc (sounds holistic haha) they were shut down by the mexican government.

Sure natural sounds warm and fuzzy and if we put doctor on the end it sounds legitimate but just like vitamins and herbal mixes there is very little oversight or regulation and so there is no way to be sure that they get consistent treatment nor that these people remain within their scope of practice.

 

[RockShox]

Oh the Sematics of the media. It is why we no longer talk about green-house effect because hey if we call it global warming we can confuse the public that they are one and the same.

Another idea lets use CAM instead so that we can make it appear as though medicine is split into two camps. It only takes a half a neuron to realize that this is invented bull. Someone mentioned it once and I will mention it again.

Anything that is theraputic, and ameliorates the suffering of the ill will ALWAYS be used and included in the practice of medicine. Anything that is not, is not alternative, it is illegitimate. I get tired of groups that have weak structure, little oversight, and limited scientific background trying to pit patients against physicians.

I worked in oncology and I got tired of patients refusing radiation for treatable cancers because they "heard" that someone could "naturally" cure their cancers by making them drink their own refined urine. Only later to come back to us long after the cancer had progressed to an uncurable stage. Do we not remember that Loretta Scott King died in a "holistic" center in mexico that had on its own extended its scope of practice into surgery, xray, etc (sounds holistic haha) they were shut down by the mexican government.

Sure natural sounds warm and fuzzy and if we put doctor on the end it sounds legitimate but just like vitamins and herbal remedize there is very little oversight or regulation and so there is no way to be sure that they get consistent treatment nor that these people remain within their scope of practice.

 

[Xerxes1729]

Jake Young has it right:

"Science complemented by non-science ceases to be science, and there are no alternatives to the truth."

 

[NSAIDAllergy]

They were originally going to title that paper, "The Effect of Fake Treatments on a Fake Disease", but felt that was being too honest.

I've said it time and again. If the "alternative" types can show in controlled trials that their claims hold water, they may be accepted (i.e. - Vitamin B2 for essential tremor,

manuka honey for cutaneous infections, etc.) Until then, skeptcism/doubt is the rule.

 

[medblazer21]

Yeah, I realize this. Neither are surgeons, radiologists, neurologists, psychiatrists, anesthesiologists or any other MD not an internist, FP or pediatrician (and sometimes OB), but you'd listen to them about medical therapy. Is it simply because they have the same degree as you, so you respect them? Would you consult a physical therapist? A dietician? A pharmacist?

I think this is the root of your stance; your inability to accept that someone who trained differently than what you feel is the "right way" may have something to offer will prevent your patients from getting the best possible care.

Why does Bastyr University claim that their ND program produces "primary care physicians" then? These people are charlatans.

http://www.naturalhealers.com/schools/bastyr

As primary care physicians, naturopathic doctors play an increasingly significant role in this growing field

Their scope of practice includes all aspects of family care - from pediatrics to geriatrics

 

[dilated]

I'm certainly not requiring you to consult with an ND. I'm not entirely sure where you are coming from on that.

*points to the thread title*

Otherwise your post was basically a non sequitur of CAM statistics.

 

[DragonWell]

Why does Bastyr University claim that their ND program produces "primary care physicians" then? These people are charlatans.

Because they take board examinations for legal licensure by states as primary care physicians, just like MDs or DOs. Their services are covered by many insurance and state health services, just as an MD or DO's would be.

http://www.aanmc.org/adm_lic/licensure.php

 

[Tired]

Because they take board examinations for legal licensure by states as primary care physicians, just like MDs or DOs. Their services are covered by many insurance and state health services, just as an MD or DO's would be.

Yes . . . "just like MDs or DOs" . . . just like us.

 

[BlackSails]

Yes . . . "just like MDs or DOs" . . . just like us.

Why just yesterday, an ND replaced my hip!

He didnt even have to make any incisions, it was amazing. He is a truly talented psychic surgeon.

 

[facetguy]

Why just yesterday, an ND replaced my hip!

He didnt even have to make any incisions, it was amazing. He is a truly talented psychic surgeon.

Has your family physician/pediatrician/psychiatrist/physiatrist/pathologist/
rheumatologist/gastroenterologist/etc been replacing hips lately?? Do you get out of the house much?

 

[SocialistMD]

I worked in oncology and I got tired of patients refusing radiation for treatable cancers because they "heard" that someone could "naturally" cure their cancers by making them drink their own refined urine.

I have a couple of very intelligent friends (she's a lawyer, he is a successful web designer) who, through a long series of interactions with MDs who couldn't figure out what was wrong with him and a PhD in immunology and nutrition suggested some dietary modifications that (in addition to his quitting the Iron Man Triathalons he would do) "cured" him. Now, they are gluten-free vegans (against the advice of this doctor) who question everything main-stream medicine says.

There is a lot of psychology that goes into cancer, as I'm sure you know (working in the field and all). Denial isn't always denying you have a disease, it's also denying you need the treatment recommended. There is also a lot of searching for alternatives because they hear the horror stories and morbidity associated with medical treatment and want to avoid that.

I don't think most NDs set out to say "my way is better," but rather look to offer adjunctive therapy that may help. If you use them as consultants, that will be their role. If your patient chooses to follow only their advice and not yours, well, that is their choice. Autonomy has both its benefits as well as its shortcomings.

 

[NSAIDAllergy]

I have a couple of very intelligent friends (she's a lawyer, he is a successful web designer) who, through a long series of interactions with MDs who couldn't figure out what was wrong with him and a PhD in immunology and nutrition suggested some dietary modifications that (in addition to his quitting the Iron Man Triathalons he would do) "cured" him. Now, they are gluten-free vegans (against the advice of this doctor) who question everything main-stream medicine says.

A few thoughts:
1. One can be intelligent and still be sucked in to BS.

2. The PhD in nutrition and immunology doesn't sound like much of a naturopath.

3. Whether or not he/she really cured him is debatable; diseases do run their courses.

4. It doesn't sound like the PhD could diagnose him either; anyone can suggest nutritional changes. Where are the large trials that validate the approach above and beyond placebo effect or plain old dumb luck?


Surely, Medicine is flawed and imperfect (Guess what? So is alternative medicine!) I don't blame them for questioning everything mainstream medicine says; it failed them. I do blame those who jump to the side of the naturopaths like lemmings. Mainstream medicine got to its position of clout and trust by clawing its way to the top and proving it had the best answers beyond a reasonable doubt in a reliable and reproducible fashion. If the naturopaths can do that someday, they may earn their way to the table. I'd love to see what they can do as well as what real doctors do.

 

[OncoCaP]

thought this was interesting:

"Dear Clinician,
Here is the information you requested (sourced from Journal Watch).

Acupuncture vs. Higher PPI Doses for GERD Patients
Can this alternative technique reduce persistent GERD symptoms in patients with incomplete responses to PPIs?

Although proton-pump inhibitors (PPIs) are the most effective therapy available for gastroesophageal reflux disease, 25% to 40% of patients who use these medications continue to suffer persistent GERD-related symptoms. The standard approach for treating such patients is to double their PPI doses, but, even at this higher level, only a subset of patients will demonstrate substantial improvement. Encouraged by the success of acupuncture in treating various gastrointestinal disorders, researchers studied whether double-dose PPI therapy (40 mg daily) or acupuncture plus standard-dose PPI therapy (20 mg daily) was more effective in controlling persistent GERD symptoms.

Thirty patients from two U.S. medical centers were randomized to standard-dose omeprazole plus acupuncture or to double-dose omeprazole for 4 weeks. The acupuncture procedure stimulated five points that, according to traditional Chinese medicine theory, regulate acid secretion and gastric motility. Acupuncture was administered three times weekly for the first 2 weeks and then twice weekly for 2 weeks. Groups were matched for age, sex, race, and body-mass index. Patients were evaluated using the validated GERD Symptom Checklist.
When baseline and follow-up scores were compared within each group, only the group that received acupuncture plus omeprazole exhibited significant improvements in daytime and nighttime heartburn, acid regurgitation, dysphagia, and mean general health scores.

Comment: Naysayers might dismiss acupuncture as "voodoo medicine," but scientific data support its therapeutic benefit for some conditions. Acupuncture has been reported to alter gastric acid secretion, enhance esophageal peristalsis, and alter visceral hypersensitivity. Although the lack of a sham control and questions about durability of acupuncture’s effect limit the validity of this trial, its findings clearly warrant further study.

— David A. Johnson, MD

Published in Journal Watch Gastroenterology January 4, 2008

Citation: Dickman R et al. Clinical trial: Acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther 2007 Nov 15; 26:1333. [Medline® Abstract]

Copyright © 2007. Massachusetts Medical Society. All rights reserved.

The above message comes from "Journal Watch", who is solely responsible for its content.

 

[rickthetwinkie]

Yeah, I realize this. Neither are surgeons, radiologists, neurologists, psychiatrists, anesthesiologists or any other MD not an internist, FP or pediatrician (and sometimes OB), but you'd listen to them about medical therapy. Is it simply because they have the same degree as you, so you respect them? Would you consult a physical therapist? A dietician? A pharmacist?

1. Care to enlighten me as to why an internist, FP or pediatrician are not qualified to be a primary care physician?
2. No, it is because they are taught modalities that are neither science or evidence-based.
3. They, along with other non-evidence based therapists, continue to further this false dichotomy within medicine.[/quote]

I think this is the root of your stance; your inability to accept that someone who trained differently than what you feel is the "right way" may have something to offer will prevent your patients from getting the best possible care.

No, the root of my stance is that I am at least well-versed enough in chemistry, biology, physics, and reality to realize that N.D.'s are trained in modalities that are implausible and based on ridiculous vitalistic principles. Whether or not that are trained in some of the ways we are does not matter when a substantial amount of their courseload is focused on the absurd.

But yeah, if reality is the "right way", then I guess I can't accept someone who is trained in make believe.

 

[rickthetwinkie]

Below are results from a pubmed search for "acupuncture randomized clinical trial." There are some top medical schools doing research in this area with NIH funding...

And that, in no way, validates the efficacy of "alternative medicine". Did you read any of those studies? Were they adequately blinded? Controlled?

And so on and so on and so on

 

[rickthetwinkie]

thought this was interesting:

"Dear Clinician,
Here is the information you requested (sourced from Journal Watch).

Acupuncture vs. Higher PPI Doses for GERD Patients
Can this alternative technique reduce persistent GERD symptoms in patients with incomplete responses to PPIs?...

After looking at the study, there are several flaws in drawing concrete conclusions from it.

1) It used no physical markers and only relied on patient reporting.
2) The study is extremely small (about 30 patients).
3) The control used was not adequate. No sham acupuncture was introduced.

Not to mention it does not in any way validate the existance of acupuncturists (you know, because Qi does not exist) nor TCM in general.

 

[SocialistMD]

1. Care to enlighten me as to why an internist, FP or pediatrician are not qualified to be a primary care physician?

Care to learn to read?

Neither are surgeons, radiologists, neurologists, psychiatrists, anesthesiologists or any other MD not an internist, FP or pediatrician (and sometimes OB),

2. No, it is because they are taught modalities that are neither science or evidence-based.

I think some of the previous posts have shown there is evidence to back at least some of what they say (and evidence doesn't back everything we do; most of the practices in medicine are not based on randomized, controlled trials, either, so you can't hold that double-standard).

No, the root of my stance is that I am at least well-versed enough in chemistry, biology, physics, and reality to realize that N.D.'s are trained in modalities that are implausible and based on ridiculous vitalistic principles.

Do you know for a fact their practices are based on nothing substantial? Do you know for a fact how everything works? I'd say the answer to both is no (I know the answer to the second is no) because we don't know everything. You can't say for sure there is not some as-of-yet-unknown scientific reason a lot of things that seem implausible or fantastical happen. I don't believe in miracles, but I do know there are things that I've seen that I can't explain. I know there is a logical explanation for them, we (humans) just don't yet know what those reasons are. Someday, we will know the answer just as some day it will be known how naturopathic remedies help.

 

[OncoCaP]

After looking at the study, there are several flaws in drawing concrete conclusions from it.

1) It used no physical markers and only relied on patient reporting.
2) The study is extremely small (about 30 patients).
3) The control used was not adequate. No sham acupuncture was introduced.

Not to mention it does not in any way validate the existance of acupuncturists (you know, because Qi does not exist) nor TCM in general.

Rick:

1. When it comes to pain, patient reporting is not a flaw. Although you can make some physical measurements of substances that are associated with pain as well as nerve activity, you can't generally use physical markers to assess pain. As things stand right now, patient reporting is the only thing that matters when it comes to pain. I'm not suggesting it's easy to work with. Until we have an automatic "pain-o-meter," patient reporting is really the most reliable and relevant metric we have. You can have two patients, one with every reason to report crippling pain and feels only a little ache ... feels great. Then you get a patient with no physically detectable ailment who reports crippling pain. You continue to treat the patient who reports the pain and send home the one who "feels fine" and has received adequate treatment for the "ache."

Take a look at the following:

The American Journal of Medicine
Volume 121, Issue 1, January 2008, Pages 79.e1-79.e7

"Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain."
PMID: 18187077 [PubMed - indexed for MEDLINE]

It does have the sham control and has about 90 participants. This still isn't huge and also not perfect, but it also is suggestive that acupuncture shows promise and is worth further investigation. It shows promising results for pain relief.

Finally, I thought your "Not to mention it does not in any way validate the existance of acupuncturists" comment was pretty funny. You can personally validate the existence of acupuncturists. Just look up acupuncture in your favorite business pages and go there personally ... you will see that they really do exist, stunning as that may be. . Ok, I think you meant that the basis for acupuncture is wrong. I would agree with you on that. However, there may be a scientific explanation if it does work. If acupuncture is safe and effective, I'm content not to know how it works, just as there are many other things in medicine that we cannot properly explain. It's not that unusual to find out that the first scientific explanation for a medical treatment's effectiveness turned out to be completely wrong as well. I do think science is the best way to study acupuncture and learn more about what is going on.

 

[Blondbondgirl]

Well, Funkless, when you prescribe tylenol, is it because you have read and can quote the quantitative drop in fever expected at the dosage you prescribe, for that individual patient, with his/her specific genetic and psychological makeup?

When you have a minute, look up the differences between Cartesian and Goethian approaches to science-it would interest me if
1-you are aware that modern medicine is dominated by the Cartesian approach
and
2-why you (personally) choose to follow it and if you uphold all clinical standards to the cartesian standards (see above example).

 

[kella]

* let me give a disclaimer* If ND's decide to get sponsored, peer-reviewed research- and there are strong positive correlations between something they exclusively administer and patient wellness, then I will retract my previous statements. But, until then...

I thought you might be interested in this link then.
http://www.helfgott.org/

I'm actually starting a project to compare education at standard medical schools and four year medical degrees at naturopathic medical schools (not online degrees, there is a difference). Specifically, I am going to attempt to compare Oregon Health and Science University Medical School to National College of Naturopathic Medicine, both in Portland, OR.

From the research I've done so far, which isn't much because our program (NCNM) is very demanding, they will be comparable. I will be happy to post my findings here in the future.

 

[AwesomO]

If the patient wants to see a ND I will not stop them. However I would never have one on the consult team. It is my consult team and I would only work with those I feel comfortable with. If the patient felt very strongly about a ND on the team I would refer to a physician who would feel comfortable with one on the team.

 

[TheMightyAngus]

From the research I've done so far, which isn't much because our program (NCNM) is very demanding, they will be comparable. I will be happy to post my findings here in the future.

Comparable to med students huh? How?
Post your study design.

 

[ClockworkDoc]

Comparable to med students huh? How?
Post your study design.

I am waiting anxiously to see how this turns out.

 

[RockShox]

I thought you might be interested in this link then.
http://www.helfgott.org/

I'm actually starting a project to compare education at standard medical schools and four year medical degrees at naturopathic medical schools (not online degrees, there is a difference). Specifically, I am going to attempt to compare Oregon Health and Science University Medical School to National College of Naturopathic Medicine, both in Portland, OR.

From the research I've done so far, which isn't much because our program (NCNM) is very demanding, they will be comparable. I will be happy to post my findings here in the future.

Sure

One thing to save you time on your research is that OHSU is actually accredited by some officially recognized source NCNM is not. They were accredited by CNME but then that organization was denied recognition by the US Dept of education several times. NCNM's MS of Acupuncture etc is accredited by ACAOM another organization that has no official recognization. So I guess that means they are not the same.

 

[kella]

Comparable to med students huh? How?
Post your study design.

I will when it is ready.

In fact, after talking to an MD who is now in school with me, we've decided that comparison of board exam material might be a better comparision.

This is a project that is going to take some time though, especially because I'm in school full time. It will happen though, and it will be posted!

 

[kella]

Sure

One thing to save you time on your research is that OHSU is actually accredited by some officially recognized source NCNM is not. They were accredited by CNME but then that organization was denied recognition by the US Dept of education several times. NCNM's MS of Acupuncture etc is accredited by ACAOM another organization that has no official recognization. So I guess that means they are not the same.

Just a quick note:
National College of Natural Medicine is accredited at both the master's and doctoral degree levels with the Northwest Commission on Colleges and Universities (NWCCU). The Northwest Commission is one of six U.S. regional accrediting bodies recognized by the U. S. Secretary of Education. NWCCU is located at 8060 165th Avenue NE, Suite 100, Redmond, WA 98052.
http://www.ncnm.edu/academics-at-nc...b_session_id=808192a9e92192e12cdac1402e7198f2

The Northwest Commission on Colleges and Universities (NWCCU) is an independent, non-profit membership organization recognized by the U.S. Department of Education and the Council for Higher Education Accreditation (CHEA) as the regional authority on educational quality and institutional effectiveness of higher education institutions in the seven-state Northwest region of Alaska, Idaho, Montana, Nevada, Oregon, Utah, and Washington. It fulfills its mission by establishing accreditation criteria and evaluation procedures by which institutions are reviewed.
http://www.nwccu.org/

Now I'm interested in a research project on accreditation, how it got started, how it works, how it is governed, etc. Just reading a little about it, it seems a little shifty doesn't it? This project would definitely include the accreditation of conventional medical schools, chiropractic schools, osteopathic schools, etc. That would then likely expand to the history of formal medical education (it has not always been thus), licensure, and regulation. Sounds exciting actually, though I may graduate before I get all of this done!

 

[Monkeyguts]

Just a quick note:
National College of Natural Medicine is accredited at both the master's and doctoral degree levels with the Northwest Commission on Colleges and Universities (NWCCU). The Northwest Commission is one of six U.S. regional accrediting bodies recognized by the U. S. Secretary of Education. NWCCU is located at 8060 165th Avenue NE, Suite 100, Redmond, WA 98052.
http://www.ncnm.edu/academics-at-nc...b_session_id=808192a9e92192e12cdac1402e7198f2

The Northwest Commission on Colleges and Universities (NWCCU) is an independent, non-profit membership organization recognized by the U.S. Department of Education and the Council for Higher Education Accreditation (CHEA) as the regional authority on educational quality and institutional effectiveness of higher education institutions in the seven-state Northwest region of Alaska, Idaho, Montana, Nevada, Oregon, Utah, and Washington. It fulfills its mission by establishing accreditation criteria and evaluation procedures by which institutions are reviewed.
http://www.nwccu.org/

Now I'm interested in a research project on accreditation, how it got started, how it works, how it is governed, etc. Just reading a little about it, it seems a little shifty doesn't it? This project would definitely include the accreditation of conventional medical schools, chiropractic schools, osteopathic schools, etc. That would then likely expand to the history of formal medical education (it has not always been thus), licensure, and regulation. Sounds exciting actually, though I may graduate before I get all of this done!

Post away, like the rest of the literature in your field it will be amusing to glance at.

My experience with NCNM:

I worked across the hall from a graduate of NCNM over a summer who told me there was major differences between her education at NCNM and mine on the hill (OHSU). She actually made copies of my 2nd year syllabi to study because she thought it was so great.

This was a graduated, board certified Naturopathic Physician from NCNM who who couldn't find a job when she finished her education.

When I left my replacement (I did over the phone surverys for about 2 months as a temp) was not only an ND from NCNM, but he also got a masters in oriental medicine. They are both still working there.

What hospital in Portland is your school affiliated with. Does NCNM have a teaching hospital? I've never once in all my wanderings of Portland area hospitals ran into a student from NCNM. Not one time.

What's your curriculum like? Do you do 10 weeks of inpatient internal medicine with every 4th nite call admitting patients and following their course? You know the regular stuff like pneumonia, CHF, COPD exacerbations to the stranger things like CMV colitis in post transplant patient or PTLD in a 20 year old with a kidney transplant.

Do you do 5 weeks of surgery at a hospital scrubbing in on a variety of cases that could range from a pituitary adenoma to a gangrenous gallbladder that was initially laprascopic but needed to transition to an open abdomen due to complications?

Do you do a month of ICU and critical care medicine taking care of post-op, trauma, seriously ill patients?

How is your OB experience? Where do you folks learn about OB? Do you have the opportunity to deliver babies/scrub in on c-sections? What about your Gynecology. The ND I worked with told me they would practice the GYN exams on one another because they didn't have enough patients? Has that changed?

The fact is your talking about two VERY different kinds of training and two VERY different fields of medicine with one being all encompassing and the other a niche market. Naturopathic medicine will never be the equivalent of Allopathic medicine.

 

[mjl1717]

I thought this was the trend what ever works!! (not alternative medicine but complimentary medicine) I believe there is at least one N.D. residency

 

[rickthetwinkie]

Care to learn to read?

My apologies. Forgive me?

I think some of the previous posts have shown there is evidence to back at least some of what they say (and evidence doesn't back everything we do; most of the practices in medicine are not based on randomized, controlled trials, either, so you can't hold that double-standard).

Acupuncture? From my survey of the literature, there is some "evidence" by EBM standards, yes. Even the Cochrane Collaboration has some "positive" meta-analyses on the subject. However, despite how valuable they are, I have problems with admitting meta-analyses as the final say on the subject. Does it work by the mechanisms they are trained in? No. Then why are they taught this? On the subject of acupuncture, if you would like a detailed treatment on the subject, there is a book that recently came out by a former NCCAM director known as Snake Oil Science that extensively discusses the evidence and finds any evidence involved (acupuncture and pain) extremely weak. That isn't necessarily the prime reason to read the book, though as it has a layman's treatment of the placebo effect and bias within the literature (which is also relevant to the CAM debate). If anything, the information on the placebo effect is informative even if you disagree with me. I'd recommend it just for that information.

And, perhaps "most of the practices in medicine are not based on RCTs, etc. etc. etc", but do most of the practices in medicine have the problem of low prior probability? That merely sticking needles in the body at certain locations developed by a ridiculous heuristic based upon the existance of energies that do not exist can cure disease? Or that drinking water that has had substances diluted out of it (homeopathy) can cure disease?

Do you know for a fact their practices are based on nothing substantial? Do you know for a fact how everything works? I'd say the answer to both is no (I know the answer to the second is no) because we don't know everything. You can't say for sure there is not some as-of-yet-unknown scientific reason a lot of things that seem implausible or fantastical happen. I don't believe in miracles, but I do know there are things that I've seen that I can't explain. I know there is a logical explanation for them, we (humans) just don't yet know what those reasons are. Someday, we will know the answer just as some day it will be known how naturopathic remedies help.

To answer your first question, are all their practices based on nothing substantial? Most likely not. They've probably been given some good nutritional education, and I'm sure there are at least some areas in which they've been adequately trained.

To answer your second question, no, I don't pretend to.

As for your conclusion, you fail to take into account the shrinking budget of the NIH and the massive competition for grant money. Should we be using limited NIH funds to examine miracles? Or should we be using limited NIH funds to examine things that have a higher probability of being useful?

 

[rickthetwinkie]

Rick:

1. When it comes to pain, patient reporting is not a flaw. Although you can make some physical measurements of substances that are associated with pain as well as nerve activity, you can't generally use physical markers to assess pain...

Perhaps I wasn't very clear. I was referring to the lack of physical markers for the disease itself, not the pain.

Take a look at the following:

The American Journal of Medicine
Volume 121, Issue 1, January 2008, Pages 79.e1-79.e7

"Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain."
PMID: 18187077 [PubMed - indexed for MEDLINE]

It does have the sham control and has about 90 participants. This still isn't huge and also not perfect, but it also is suggestive that acupuncture shows promise and is worth further investigation. It shows promising results for pain relief.

It is a larger and better conducted study, it seems. However, I don't see the promising results for pain relief. The differences between the groups on pain were not significant. Perhaps I'm not looking carefully enough, though, so if you have some idea on where it is, could you let me know?

Also, taking into account their primary endpoint, it seems that it does "say that". However, when looking at the mean NIH-CPSI scores, none of the differences barring the one at the 10 wk mark were significant, so I find that conclusion based on this study just a tad fishy. Also, many of their secondary endpoint scores were not significant, which I find interesting.

Finally, I thought your "Not to mention it does not in any way validate the existance of acupuncturists" comment was pretty funny. You can personally validate the existence of acupuncturists. Just look up acupuncture in your favorite business pages and go there personally ... you will see that they really do exist, stunning as that may be. . Ok, I think you meant that the basis for acupuncture is wrong. I would agree with you on that. However, there may be a scientific explanation if it does work. If acupuncture is safe and effective, I'm content not to know how it works, just as there are many other things in medicine that we cannot properly explain. It's not that unusual to find out that the first scientific explanation for a medical treatment's effectiveness turned out to be completely wrong as well. I do think science is the best way to study acupuncture and learn more about what is going on.

Yes, perhaps I wasn't being clear. My point was that acupuncturists are trained in a way that has no basis in reality unless you buy into it. So why have acupuncturists diagnosing you with "liver Qi deficiency" by looking at your tongue? Why even introduce the concept of Qi at all?

And on your last point, I actually agree that, yes, the first explanation for a treatment's effectiveness can turn out to be completely wrong. However, at least before these treatments were proposed, they, in all likelihood, had prior probability on their side, and, even if completely wrong, at least they had a coherent reasonable argument for their hypothesis.

If necessary, I will come back to this thread and try to help explain my positions further if there is more discussion, however, I have to make a flight! lol

 

[8744]

I was reading something by a small cell lung cancer patient the other day. The pt. said they wanted to bring a naturopath on their medical "team" to consult on nutrition, complementary therapies, etc., but their oncologist flat-out refused to consult with the ND. If you were dealing with a patient who was compliant and accepting of traditional treatment, would you consult with an ND at the patient's request, especially in cases like SCLC where the "success" rate is low?

No, for the same reason I won't refer to an acupuncturist, a chiropractor, or a homeopath...essentially because 99.3 percent of complementary and alternative medicine is completely ridiculous and the 0.7 percent that is not ridiculous isn't worth the money and effort.

May as well ask me to consult a Tarot card reader or a psychic. I'm not going to do it because it's ridiculous.

 

[8744]

Post away, like the rest of the literature in your field it will be amusing to glance at.

My experience with NCNM:

I worked across the hall from a graduate of NCNM over a summer who told me there was major differences between her education at NCNM and mine on the hill (OHSU). She actually made copies of my 2nd year syllabi to study because she thought it was so great.

This was a graduated, board certified Naturopathic Physician from NCNM who who couldn't find a job when she finished her education.

When I left my replacement (I did over the phone surverys for about 2 months as a temp) was not only an ND from NCNM, but he also got a masters in oriental medicine. They are both still working there.

What hospital in Portland is your school affiliated with. Does NCNM have a teaching hospital? I've never once in all my wanderings of Portland area hospitals ran into a student from NCNM. Not one time.

What's your curriculum like? Do you do 10 weeks of inpatient internal medicine with every 4th nite call admitting patients and following their course? You know the regular stuff like pneumonia, CHF, COPD exacerbations to the stranger things like CMV colitis in post transplant patient or PTLD in a 20 year old with a kidney transplant.

Do you do 5 weeks of surgery at a hospital scrubbing in on a variety of cases that could range from a pituitary adenoma to a gangrenous gallbladder that was initially laprascopic but needed to transition to an open abdomen due to complications?

Do you do a month of ICU and critical care medicine taking care of post-op, trauma, seriously ill patients?

How is your OB experience? Where do you folks learn about OB? Do you have the opportunity to deliver babies/scrub in on c-sections? What about your Gynecology. The ND I worked with told me they would practice the GYN exams on one another because they didn't have enough patients? Has that changed?

The fact is your talking about two VERY different kinds of training and two VERY different fields of medicine with one being all encompassing and the other a niche market. Naturopathic medicine will never be the equivalent of Allopathic medicine.

That's exactly it. It's like chiropractors claiming to be primary care physicians. Now, it may be that we just have a different idea of what a primary care physician really is but surely having a comprehensive background in common diseases, their treatments, and complications as well as the knowledge to know when to consult a specialist is important and not something that you get in any variety of woo school you care to mention.

In other words, there are "straight" chiropractors in my town who advertise themselves as complete physicians for all of your family's health needs (from pediatrics to geriatrics) and claim that their treatment modality, adjustments of the spine, is all you need to treat every disease under the sun. And yet, when they get a really sick patient they call 911 and send them to me so fast that your head will spin.

Now, real doctors send their patients to specialists and to the Emergency Department but the difference is that they are not "jumping" modalities, just level of care. When the chiropractor, again as an example, sends a patient to a real doctor after having claimed to be able to treat real disease, he is admitting that his profession is worthless, else there would be "Chiropractic Hospitals" with Chiropractic Emergency Departments where the patient could get the same modality but at a higher level of care.

The truth is that CAM practitioners do not receive enough medical training in real medical problems to be primary care physicians as most of their training is spent mastering their own particular brand of snake oil. It may be that some states credential them for Primary Care but this is more the result of lobbying and money being spread around, not to mention the general scientific ignorance of most people including politicians.

The actual practice model of many "Primary Care" alternative practitioners is to, for example, do their little placebo thing but quickly consult a real doctor for any real medical problem. If this is the case, then CAM is just another expensive layer added to medical care and a largely useless one at that to complement the uselessness of a lot of what we do even in the real world of medicine. Unfortunately, I have also seen many patients with florid presentations of otherwise very treatable diseases whose CAM practitioners, true to the adage that A Little Knowledge is a Dangerous Thing, took their quackery fairly seriously and didn't know when to call in a real doctor.

 

[fakin' the funk]

In this case I think the best course of action is to mock the patient THEN refuse to consult with the ND.

Agreed!

 

[M.Furfur]

As has been stated before, this isn't about you, it is about your patient. If your patient wants a naturopath, there is little harm that can be done, particularly if you have the final say as to what is done.

I agree with your reasoning. However, my concern is with the boundaries. Like what's next consult with a psychic or a voodoo witch?

 

[Hurricane95]

No.

That would be a waste of everyone's time. I don't care what the patient does in his own time as long as it doesn't interfere with his primary care. However, in most cases, I'll probably advise him/her not to do it because there's a good chance they'll start popping some chinese herb pills or something (and not tell his docs) and then worsen the situation with a bonus transitional cell carcinoma of the bladder.

 

[MacGyver]

Because they take board examinations for legal licensure by states as primary care physicians, just like MDs or DOs. Their services are covered by many insurance and state health services, just as an MD or DO's would be.

http://www.aanmc.org/adm_lic/licensure.php

So what? Audiologists, physical therapists, and nutritionists are also licensed and able to bill health insurance for various counseling/tests/therapies.

Are you now claiming that audiologists, physical therapists, and nutritionists are all primary care physicians?

Do you even know what the term "primary care physician" means?

 

[Toohotinvegas33]

What are the legal aspects of letting an ND at your patient?

Pt present with signs of GERD, but ask for his ND, ND says he is having an acid imbalance with citrus fruits and prescribes herbal tea, patient whats to be discharged.

3 months later

Pt has Barretts esophagus.


If this went to court, would the ND be held accountable or would the blame be held of the real doctor?

 

[spreebee]

Wow I didnt know what these naturopaths are up to. Intravenous ozone injections? WTH is that?

As for team rounds, the only way I would allow that is if the ND brings me evidence-based papers every day to justify their recommendations. No papers = no rounds. I think that would clear this up very quickly.

There is actually an M.D. near my area that uses OZONE injections for cancer patients... He is experimental, but it's free radical formation is suppose to attack the cancer cells lacking the enzymes to protect them from free radicals (while the healthy cells protect themselves from the free radicals)...Some people say it's bogus some people say it works.... That is the theory behind it....