Will Massachusetts legitimize naturopathic pseudoscience this year?

Will Massachusetts legitimize naturopathic pseudoscience this year?

Will the 11th time be the charm for naturopathic licensing in Massachusetts?There will be a public hearing on Tuesday, November 17, on a pair (S1205, H1992) of naturopathic licensing bills before the Joint Committee on Public Health.(Technically, the bills permit naturopathic registration, not licensing, but that is of little practical difference under the Massachusetts law.)

It is ironic indeed that a committee called "public health" would consider bills permitting naturopathic doctors to legally practice. Naturopaths are notoriously anti-vaccination, although they won't admit it, preferring to couch their opposition in dog-whistle terms like vaccine "safety" and "parental choice." Unfortunately for them, someone actually checked the stats, which showed that pediatric patients seeing naturopaths were more likely to be unvaccinated and more likely to actually acquire vaccine-preventable diseases.Their patients are also less likely to get other preventive care, like cancer screening. It is a testament to the fear of this deleterious effect on public health that these bills require a naturopath to refer patients under 18 to a primary care physician if the patient has not been immunized.

An illuminating example of naturopathic "public health" makes its home in the state of Massachusetts. Two naturopathic doctors, Paul Herscu and Amy Rothenberg, run the New England School of Homeopathy, as well as Herscu Laboratory, in Amherst. Herscu and Rothenberg practice naturopathy across the border in Connecticut, where naturopaths are licensed, and would be eligible to legally practice in Massachusetts if the registration legislation passes.

Herscu fancies himself a scientist and expert on infectious disease epidemics, but his public health advice is straight from the 18th century. He advocates homeopathic treatments for diseases like Ebola and influenza and is actually worried that, during an epidemic, there won't be enough homeopaths around to treat people. He and Rothenberg also use homeopathy to treat children with autistic spectrum disorder.

Homeopathy, of course, is quackery of the worst sort.  As David Gorski, MD, PhD, described it over on SBM:

"When it comes to quackery, few can even come close to homeopathy for the sheer ridiculousness of its precepts. Whether it is the Law of Similars, which claims that to cure a disease you need to use a substance that cause's that diseases symptoms in healthy people, a "law" that has no basis in science, or the Law of Infinitesimals, which postulates that serially diluting a substance to nonexistence in the solution—with vigorous shaking (succussion) to "potentize" the mixture between each dilution step, of course—makes it stronger, few quackeries bring the pseudoscience to such a high level as homeopathy. Indeed, as I frequently like to say, for homeopathy to work, not only would much of what we know about physics and chemistry have to be wrong, but spectacularly wrong. . . . Few quacks can create a self-contained, self-sustaining world of pseudoscience the way homeopaths can."

Yet, the use of disproven treatments like homeopathy is perfectly consistent with naturopathic practice.  As explained by Scott Gavura, D.Pharm.,

"Now let's turn to the advice provided by naturopaths. In contrast with science-based medicine, there is no clear standard of care with naturopathy – owing to the fact that naturopathy is not based on science or evidence. It is a belief system, or philosophy. Understanding this makes naturopathy a little less baffling – otherwise how could disparate and scientifically-contradictory practices like homeopathy, acupuncture and herbalism all be considered acceptably "naturopathic"? Given there is no requirement to rationalize naturopathy in scientific terms, pretty much anything goes. I've used this quote before, but it accurately reflects how naturopaths appear to assess evidence and decide what is "naturopathic" and which will be ignored:

'I love being able to look at new approaches that may come along and to ask myself, "Is this within the bounds of the philosophy I so embrace?" And if not, to let it go.'  Amy Rothenberg, Naturopath"

Legislation allowing people like Rothenberg and Herscu to legally diagnose and treat with homeopathy will only serve to legitimize these useless and potentially dangerous practices.The bills would allow naturopathic doctors to diagnose and treat any patient of any age with any disease or illness and homeopathy is one of those treatments specifically authorized.They would be able to do physical exams and order clinical, laboratory and radiological diagnostic procedures. The only limitation is on the treatments they use, which exclude surgery, prescribing drugs. 

Although they would be forbidden from using the title "physician" and cannot claim they provide primary care, as a practical matter, they will be able to practice as primary care physicians limited only in the range of treatments they can offer. Indeed, many naturopathic doctors claim they can manage a broad range of conditions and diseases that any decent primary care physician would refer to a specialist. One Massachusetts naturopathic clinic advertises treatment for autism, cervical dysplasia, cancer, Lyme disease, and hyperpigmentation, bipolar disease and arthritis. What primary care physician claims that sort of expertise?

Massachusetts naturopathic doctors are already freely diagnosing patients with questionable methods for which they are widely known, all under the guise of "promoting health" and "preventing disease." They need this legislation to legalize what they are already doing in practice.They advertise, for example, treatment of "adrenal fatigue," a disease fabricated by naturopaths and diagnosed based on vague symptoms and spurious lab testing.  In fact, several offer what they call "unique" or "progressive" lab testing, which are buzzwords for "unvalidated."

One Massachusetts naturopathic doctor claims a specialty in cancer treatment. In fact, so accomplished is he that he uses blood tests to detect "growth factors and immune imbalances" and treats these with various concoctions that, he says, keep the cancer in remission. Oddly, none of these allegedly highly effective protocols have been adopted by medical science. Another claims medical doctors are missing the boat in diagnosing and treating thyroid disease. This naturopathic "expertise" in thyroid disorders has proven problematic for the unfortunate patients who actually have thyroid issues by imperiling effective treatment prescribed by their physicians, leaving the physicians puzzled and frustrated that someone who doesn't know what they are doing is interfering with their patients' well-being. (Other medical doctors have experienced similar frustrations in treating patients who've seen naturopaths.)

The bills would allow self-regulation through a "board of registration in naturopathy." This board would write the regulations governing naturopathic practice, making naturopaths virtually immune to effective regulatory control. Because naturopaths establish their own standard of care, which is essentially no standard of care,  practicing naturopathic doctors are able to offer substandard medical care without fear of discipline. Passage can mean eligibility for insurance coverage for naturopathic services under the provisions of the Affordable Care Act.

There are many bills before the Public Health Committee on Tuesday. Some of these propose a practice expansion for other health care professions, like advanced practice nursing, which will undoubtedly bring opposition from the medical community. This will allow the naturopaths to play the "turf war" card, which they use to write off legitimate criticism. Fortunately, this will also mean that naturopaths will be given little time to make their case. (And, mark my word, it will be full of overblown statements about their education, training, and their ability to prevent and treat disease, with some sympathetic testimonials thrown in. This is their typical modus operandi in licensing hearings.)

Don't be lulled complacency by the fact that this is the 11th attempt to pass a naturopathic registration bill. Massachusetts has come dangerously close before, to the point of bills passing in both the House and Senate, only to be vetoed by the Governor. In other years, bills have made it through at least one house of the legislature.

We've written about naturopathy many times on Science-Based Medicine. Britt Hermes, a former naturopathic doctor herself, has posted there, as well as on her on blog, Naturopathic Diaries. You can also find information on Oppose Naturopathic Licensing. It is impossible to catalog the many reasons naturopaths shouldn't be given undeserved legitimacy through licensing or registration in this short post. But, if you read the posts listed below, you'll quickly become convinced of the folly of such legislation.

Update: Naturopathic Diaries also posted on the naturopathic registration act. The screen shots of Massachusetts naturopathic doctors' websites say a thousand words about their practices. 

Naturopathic practices

Naturopathy vs. Science (diabetes, autism, fake diseases, infertility, prenatal vitamins, vaccination, allergies)

Herbalism

Colloidal silver

Allergies

Hypertension

"Magic socks"

Genetic testing

Cervical dysplasia (also here)

"Organ repositioning"

Vitamin injections

Miscellaneous posts on naturopathic practices:

What naturopaths say to each other when they think no one's listening

Disingenuous: Deconstruction of a naturopathic white paper

A liquid that was almost, but not quite entirely unlike, tea

Education, training and ethics

Part I: Clinical training inside and out

Part II: The accreditation of naturopathic medical education

Wild west: tales of a naturopathic ethical review board

The price of a naturopathic education

What does ND mean?

Other blogs

Naturopathic Diaries

Oppose Naturopathic Licensing


Points of Interest 11/15/2015
Points of Interest 11/13/2015

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