Oregon Naturopaths as Primary Care Providers: What THEY do not want you to know.

Oregon Naturopaths as Primary Care Providers: What THEY do not want you to know.

I ran across A Win-Win for Oregon: Naturopathic Doctors as Primary Care Providers over on the Lund Report.

Written by an ND, it is wrong from the opening paragraph.

Naturopathic doctors who absolutely meet the standards of care as required by the state are an underutilized resource and diagnose and treat the entire gamut of conditions.

Naturopaths may meet the standards required by the state, but they lack virtually all the requirements needed to diagnose and treat the entire gamut of conditions seen as primary care providers.

The opinion piece is filled with half truths and appealing platitudes. But it is what is not mentioned, what THEY do not what you to know, are the facts that reveal NDs should not have been declared primary care providers by the legislature.

One constant is that naturopathic medicine is founded in science—NDs are required to study the basic, biomedical and clinical sciences for two years.

Although allegedly grounded in science, science is ignored in vast swaths of ND education. Practices divorced from reality such as  homeopathy, acupuncture, colonics, and energy medicine, are the basis of ND education. Pseudo-science is baked into the ND education. And time spent in the pseudo-sciences is time not spent in reality based medicine. For a sobering description of the reality of ND education, I refer you to the Naturopathic Diaries, written by an ND, a graduate of Bastyr.

As persistent myths are clarified about our practice, licensed states have doubled, active NDs in the field have tripled, and NDs in Oregon are licensed primary care physicians.

Less a clarification of persistent myths and more successful advertising. The licensure of NDs by Oregon is, unfortunately, the medical equivalent of legislating astrologers to be the equivalent of astronomers or alchemists to be the equivalent of chemists.

Our foundation is anchored in natural healing, including botanical science, nutrition, hydrotherapy, physical medicine among others.

Among others. As usual they fail to mention all the pseudo-medicines that are the lifes blood of the ND practice. A perusal of ND websites finds almost every curious practice imaginable, from homeopathy to craniosacral therapy to plant stem cell therapy to the O-shot to detoxification. There is no ND that avoids pseudo-medicines and no pseudo-medicine not used by some ND in Oregon.

In the past 20 years there has been an increasing focus on other therapies our patients require—pharmaceuticals, for example, broad lab testing, and a proliferation of natural research.

Questionable and unvalidated lab tests, from Lyme to saliva tests to hair analysis to live blood analysis to biomeridian analysis, are also part of the ND pseudo-medical armamentarium. Just as there is no pseudo-medical intervention unused in ND practice, there is no pseudo-scientific test not utilized.

NDs know from clinical experience and years of education the interactions that can arise between a prescribed herb and, say, a diabetic medication.

Years of education? Compared to their MD/DO counterparts ND education is lacking in reality based practice and few have the extended post-graduate training required by MDs to learn their profession. No medical student has ever been ready for patient care upon graduation; it is why there are residencies. Most NDs go straight from school to practice with a fraction, 15,000 fewer hours, of training compared to a Family Practice physician. And since many of the ND training hours are not in science-based medicine,  the 6000 hours of ND training are a fraction of the realty-based training needed for competent patient care.

NDs, unlike their medical counterparts, practice whole-systems medicine.

Except that their whole system approach is not based in reality. Part of the appeal of ND's is their philosophy, which is superficially attractive but fails when its implementation is examined. NDs have excellent advertising, with all the appeal, and reality, of a light beer commercial.

Besides being educated in pseudo-science and practicing virtually every pseudo-science imaginable, NDs also treat diseases that do not exist (chronic Lyme, chronic Candida, adrenal fatigue, toxins as examples) with therapies that do not work or are dangerous, such as chelation and colonics.

Naturopaths are generally anti-vaccine and oppose mandatory vaccination laws. As a result, children are significantly more likely to be diagnosed with a vaccine-preventable disease if they receive naturopathic care.

When compared to MD's, naturopaths do an inferior job at primary care, falling short in cancer screening and vaccination.

NDs have unethical practice. Many naturopaths sell unneeded supplements and homeopathic nostrums from their clinic or website, a fundamental conflict of interest avoided in the MD practice. MDs are inaccurately accused of being under the influence of Big Pharma, but it pales in comparison to the sales of Big Supplement for profit in the typical ND office.

NDs have no quality improvement. There has never been a change or abandonment of an ND/alternative medical practice because it has been demonstrated to be useless or dangerous. Naturopathic practice, like all alternative practice, is immune to data even when it improves patient safety.

Naturopaths claim to stress prevention and consider the whole patient, but that's only what every good MD does. What NDs do that is good is not special, and what they do that is special is not good.

And the author uses, to my ear, the slightly creepily racist term "Western medicine." There is no Eastern, Western, Alternative or Allopathic Medicine. There is just medicine: interventions that have been demonstrated to be effective in the care of patients. And most of the ND interventions have failed to demonstrate effectiveness or even to be based on scientific reality.

There is little doubt that the court of public opinion is changing in favor of naturopathic medicine. What has changed in recent years to shift the perception of naturopathic medical care from "alternative" to "primary" care?

I think it is because ND's have become very good, as this article demonstrates, at obfuscating the truth about ND practice. Half truths and an appealing natural philosophy in place of an honest, complete description of ND practice.

Insurance coverage is another. NDs are covered by Medicaid through the Oregon Health Plan and CareOregon. With the exception of Oregon Health COOP and LifeWise, insurance carriers still balk at covering natural medicine. Aetna, for example, recently served notice to NCNM that it did not recognize our status as primary care providers in Oregon. That company's logic, despite federal and state legislation to the contrary, stems from recognizing NDs only as "alternative care" practitioners, not as PCPs. For companies like Aetna, this categorization guarantees that naturopathic doctors will continue to be reimbursed significantly less for performing the same services as medical doctors.

It is clear from their education and practice that whatever it is that NDs do, it is not performing the same services as medical doctors and their payment appropriately represents this reality. That my premiums are wasted on the practice of pseudo-medicine even at a reduced rates is shameful.

We can ameliorate the critical shortage of PCPs. The state of Oregon recognizes us. The Affordable Care Act recognizes us…At the same time, NDs who absolutely meet the standards of care as required by the state, are an underutilized resource. We believe that the rising chronicity rates in America, coupled with an acute shortage of PCPs, is a strong argument that it's time to remove all the remaining barriers to quality standards of care from all licensed, qualified providers. The team of practitioners at NCNM is ready and able to take action in support of every patient's health.

In every aspect of their education, training, and practice naturopaths are not qualified to be a primary care providers, despite the legislature declaring it so. There are enough difficulties getting real, useful care reimbursed. Those limited resources should not be wasted on naturopathic care.

There is a shortage of primary care providers in Oregon. The wrong solution is paying providers who are educated in pseudo-science, trained in pseudo-science and practice pseudo-science. As Simon Singh noted, just because there are issues with the airlines does not mean we should use magic carpets.

And now you know.

Oregonians deserve better.

Points of Interest 10/22/2015
Point of Interest 10/19/2015

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