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Can't get into med school? Legislate your own doctorate!

Posted on: June 9, 2008 11:18 PM, by PalMD

I guess it's not just doctors watching this one---an alert reader and
a fellow SciBling both picked up on this one. Apparently, in my
neighboring state of Minnesota (really, check the map), home to Greg
Laden, PZ Myers, and lutefisk, doctor wannabes have legislated
themselves into "doctorhood". You see, there is this entity called a
"naturopath", or "naturopathic doctor", which is some sort of shaman
that likes to think that if you study woo long enough, it becomes
science.

OK, OK, I'll settle down, but let's examine this "naturopath" thing.
You see, to be a real doctor, you must attend a medical school that is
certified by a national organization, and to be licensed to practice,
you must finish an accredited residency program and apply to the state
for a license. Medical schools and residencies are very closely
monitored and must meet exacting (and consistent) standards. There are
a few associations for naturopaths, but no requirements equivalent to
say, being a certified master plumber. For example, the American
Naturopathic Certification Board, one of the entities that "certifies"
naturopaths, states:

The preferred credential for taking the examination in Nutritional
Wellness is a masters level degree in nutrition, while the preferred
credential for taking the examination in Traditional Naturopathy is a
doctoral degree, either N.D. or Ph.D.

However, recognizing that education can be a combination of formal
education, practical experience, apprenticeships or other modes of
experiential learning, applications from individuals with such
education will be evaluated.

In other words, they prefer education, but, hey, if you can't manage
that, just make sure you've been an uncertified practitioner for a
while.

They claim to have a science-base education but teach such ridiculous
and disproved ideas as homeopathy.

Naturopathic "medicine" is a funny idea. It is, according to one
organization (and they all pretty much say the same thing):

... a system of medicine that assists in the restoration of health by
following a set of specific rules. A basic assumption is that nature
is orderly, and this orderliness is designed to result in ongoing life
and well being. This dependable orderliness is believed to be guided
by a kind of inner wisdom that everyone has. This inner wisdom can be
assisted to return a person to their best balance by naturopathic
treatments.
"Inner wisdom"? Excuse me, but WTF?!? Science-based medicine is all
about learning to avoid reliance on "inner wisdom" and common sense,
as these tend to be poor guides as to what treatments are and are not
effective.
Minnesota is in trouble. Arizona has gone down a similar road with
homeopaths and other non-doctors, and they've had some serious
problems. The reason we have a consistent and regulated system of
bestowing the title of "doctor" and the license to practice is that
we, as doctors, have a unique ability to heal and to harm. Having a
consistent and well-regulated system takes out some of the guess-work.
Even if we cannot be sure of the excellence of every licensed
physician, we at least know that they have received the same or
similar education and training as their peers. Real doctors receive a
proven, science- and evidence-based education. All the others are just
wannabes.

Look, if naturopathic school is so rigorous, just go to medical
school. We can always use compassionate, intelligent primary care
physicians, and we promise to give you an education in the real
science of healing.

Sorry, but we don't teach inner wisdom. We gave that up a few decades
ago when we realized it didn't work.

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Comments
On a related topic, do you think we need more doctors and/or medical
schools? Medical schools turn away so many candidates; surely at least
some of those would make decent enough doctors.

Posted by: synapse | June 10, 2008 12:13 AM

Real doctors receive a proven, science- and evidence-based education.
Not any more. As Orac has frequently pointed out, real medical schools
are now teaching woo right along with science based medicine.
Posted by: Dan | June 10, 2008 6:37 AM

I consider naturopathy the ultimate in quackery. Some people say that
about homeopathy (because they tell you there is no remedy in their
remedies); but naturopathy exceeds homeopathy by adopting it, along
with every other stupid idea. One ND advocates taking a bath in water
with a little hydrogen peroxide in it as a treatment for asthma.
Apparently, she is unaware that peroxide is not oxygen, and that the
technical term for trying to absorb oxygen (in water) through the skin
is "drowning."

http://www.naturowatch.org/ (a subsite of www.quackwatch.org) has a
good description of this quackery. Dr. Atwood also has an article in
Medscape (2003) and two articles in "The Scientific Review of
Alternative Medicine" (2005). He estimated there were 34 naturopaths
seeking licensure in Massachusetts in 2002. I live in the most rural
county in the state; but there are two (yes, 2!) within walking
distance of my apartment (I feel blessed). They practice "medicine"
here, without licenses.

One can often find a list of "naturopathic principles" that begins:
1. the body heals itself.
2. First do no harm ...
Do they know what "first" means?

I find the Minnesota regulation interesting because they seem willing
to license anyone; whereas, in the other cases I am aware of, the NDs
argue licensure should only be granted to those who have N.D. degrees
from accredited schools. The inclusiveness must represent "Minnesota
nice." Oh yah, you betcha.

Posted by: Joe | June 10, 2008 7:36 AM

Isn't it against the law to practice medicine without a license? Is
there some legal definition of "practicing medicine without a license"
that keeps these people out of jail? Or are there just too many to
prosecute?

Posted by: Oldfart | June 10, 2008 8:45 AM

Just to emphasize a point, it's my understanding that becoming a
certified plumber - or electrician, or any kind of contractor - will
be significantly more difficult than becoming a certified naturopath
"doctor".

Posted by: jeffk | June 10, 2008 9:47 AM

It seems to me that *some* "alternate therapies" *may* have some
beneficial effect. Consider acupuncture. The explanation for its
action presented by practitioners is all hooey (channels of energy)
yet people report positive results. Proper (double blind) studies
could be done to determine if the procedure is both safe and
effective.

Big Pharma won't do it as there is no money for them in it. That
leaves government- and university-funded research. I imagine any
researcher of note would be reluctant to propose such a study.

Gotta run, but you have the basics of my idea here.

tomS

Posted by: tomS | June 10, 2008 9:58 AM

Dan: Not any more. As Orac has frequently pointed out, real medical
schools are now teaching woo right along with science based medicine.

They should be teaching woo. GPs are going to run into it, and they
need to know both what woo practicioners are doing to their patients,
and how to talk to their patients. On top of that, some good medicine
is done by woo practicioners, on top of the woo -- a lot of the long-
term tracking (for diabetes, etc) is done by chiros and
acupuncturists, which GPs often nowadays ignore in this age of 15
minutes, pay by the cap, practice.

The problem isn't that kind of woo --- it's this woo they call "case
management" which is just following an algorithm with your patients
--- aka, try different sh.t until your patient gets better or dies.
That's "science woo" --- imagine an engineer who argued that bridge
repairs should be done that way!

Posted by: frog | June 10, 2008 11:05 AM

I believe that one can also go the ND route in Connecticut.ND's
advertise in our free local Woo Age magazine, one "practices" in
NJ( she's also Ayurvedic) and others in southern NY state, the Hudson
valley, which is a vortex for this sort of thing.Come to think of it:
with all of these imaginary diseases popping up, imaginary doctors
just might find their work cut out for them.(An added benefit: no
competition from EBM!)

Posted by: Denice Walter | June 10, 2008 11:38 AM

@frog,

Where do you get your information? The quackery taught in medical
schools is almost always presented as if it were real therapy. That is
not good. On the other hand, if it were explained as the nonsense it
is, that would be valuable.

As for chiropractors and acupuncturists dealing with diabetes- that is
disturbing, if true. They know nothing about it, and their
"treatments" are particularly irrelevant.

Woo practitioners do not practice medicine at all, let alone "good
medicine." There are a small number of rational chiropractors who
disavow the core of chiropracty (subluxations and Innate Intelligence)
and only offer massage and some mobilization; but they are not
chiropractors, except in title. They say the difference between a
rational chiro and a large pizza is that the pizza can feed a family
of four.

@Oldfart,

How can they practice illegally? It's a good question and I will ask
around; but I don't think I will have a timely answer (for this
thread). I think they fly below the radar (at least until they kill,
or seriously harm, someone).

I recall James Randi trying to get police/prosecutors to pay attention
to a "psychic surgeon" practicing in Florida, and they thought Randi
was a joke.

Posted by: Joe | June 10, 2008 12:06 PM

tomS,

A number of acupuncture studies have been performed already, which
show no skill beyond the placebo effect. This includes "sham"
acupuncture in which the needles were inserted randomly or
incorrectly. The latter type of study is single blind. I don't know if
a truly double blind study has been performed, where the practitioner
doesn't know if the needles are being inserted properly or not. I
remember reading about the development of special needles for this
purpose (you activate a plunger which may or may not actually insert
the needle). I don't know if studies using them have been performed
yet.

Posted by: Ambitwistor | June 10, 2008 1:04 PM

Actually, it goes well beyond that Ambitwistor. At least one person
that was "previously" an advocate of acupuncture tested it using
bandaids that had a small bit of rubber or something in them (for
sanitation). Apply the bandage, then stick in the needle, which is
"held" by the bandage, but never actually goes into the body. Same
identical results. They featured the guy on Penn & Teller's show on
showtime, I think. And, he did the same thing with acupressure.
Finding that what mattered was if the "practitioner" seemed to believe
in it and had a complicated and technical sounding enough
"explanation" for how it was supposed to work. Gosh! Sounds almost
like "placebo". lol

Posted by: Kagehi | June 10, 2008 1:30 PM

Where can I get one? I'd like to be a therapist for post-
fundamentalism stress disorder (PFSD) in religious de-converts.

Posted by: TheNerd | June 10, 2008 2:27 PM

The American Naturopathic Certification Board (quoted in the article
above), is not a legitimate organization and their members are not
eligible for licensure in the 16 states that license naturopathic
doctors, including Minnesota. In fact, it brings to light the
necessity of licensing legitimate naturopathic doctors.

In order to be licensed as an ND in states that recognize naturopathic
doctors, graduates must attend a 4 year naturopathic medical school
and also pass a national licensing exam. To be accepted into a
naturopathic medical school, students needs to obtain a bachelor's
degree with the same premed requirements as someone that attends a
conventional medical school. Naturopathic medical schools are also
accredited through the federal government by the same accrediting
agencies as conventional medical schools. Students of naturopathic
medical schools must complete around 5000 hours of classroom and
clinical rotations, the same and in some cases, more than many
conventional medical schools. The only deficit that naturopathic
doctors face is in residency training. Because the profession is still
very small, there are not enough opportunities for students to
complete 1-3 year residencies, which is changing. Osteopathic doctors
had the same problem 30 years ago, however in many states residencies
for MD's and DO's are not mandatory either.

This brings me to the point that naturopathic doctors should be
licensed in all 50 states, because they do receive adequate medical
training and licensure allows the general public to differentiate
between a true naturopathic doctor and someone that takes a couple
online courses.

Posted by: Ted Suzelis, ND | June 10, 2008 2:38 PM

Joe:
Where do you get your information?
I do research in a medical school. Of course, those who teach it are
practicioners, therefore they will teach it as working. Do you expect
the medical schools to hire anthropologists? We're not talking about
teaching 8 year olds, but medical school students -- if they can't
distinguish woo from non-woo, you ain't going to "teach" them by
telling them what is woo.

As for chiropractors and acupuncturists dealing with diabetes- that is
disturbing, if true. They know nothing about it, and their
"treatments" are particularly irrelevant.

That's laughably over-simplistic. A great deal of diabetes treatment
is a) recognizing it early b) tracking nutritional habits often and
explicitly. An decently trained acupuncturist is actually more likely
to do a good job of that than an MD. They see their patients more
often, they apply old-fashioned diagnoses such as looking at their
patients closely and smelling them closely (which is much more likely
to id diabetes very early on than waiting for an acute episode), and
talk to their patients regularly about their nutritional habits.

Treatment of many chronic conditions doesn't require medical school
and residency, but basic training in psychology, nutrition, close
observation, and a basic physiological knowledge. Even for some acute
conditions, a decent acupuncturist is more likely to pick up on
melanomas and such earlier than the GP so they can be referred up the
chain.

Just like public health has done more to help health than all the MD
of the last century, the most efficacious treatment that in general
extends life is not the acute treatment that medicine excels at, but
the old fashioned shamanistic work of having a basic knowledge of
physiology and psychology. A well-trained woo practitioner can do that
--- if they're trained well enough to know when to refer folks up the
chain. They can do what GPs used to do, but are no longer trained to
do, are economically incapable of doing, and are positively mistrained
for.

The fact that their treatments are placebos is irrelevant -- for the
right conditions. If I have pain, and a placebo makes it go away, I
could give a crap about "scientific significance". If woo can convince
someone to eat their veggies, or make them less depressed, why should
they pay someone at 10-100x the rate to get some scripts that are
likely to do significant harm? Woo which disregards medicine is
dangerous, but woo which supplements and respects medicine can be the
most efficacious means of delivering basic health.

Posted by: frog | June 10, 2008 3:04 PM

I knew lutefisk couldn't be good for you.

Posted by: Cherish | June 10, 2008 3:04 PM

Ted Suzelis,quack,

As I said, your kind berate other NDs. Their information is as well
founded (not) as yours. Go to www.naturowatch.org and tell us which,
critical, articles are wrong. Beware, nobody has ever returned from
such a mission.

Posted by: Joe | June 10, 2008 4:00 PM

The new Minnesota law registering naturopathic doctors was not opposed
by the State Medical Association. Registered NDs will be under the
jurisdiction of the State Board of Medical Practice just like MDs.
The American Naturopathic Certification Board has absolutely nothing
to do with the practice of naturopathic medicine as regulated in 15
states, including Arizona, California, and now Minnesota.
Organizations such as ANCB owe their existence to the the fact that
naturopathic medicine is not regulated in majority of the states.
The fact that the author considers ANCB as representative of the
naturopathic medicine shows that people do not understand the
difference between qualified naturopathic doctors and those
individuals who receive correspondence school 'Doctor of Naturopathy'
diplomas, and who are not eligible for licensing or registration.
Licensed naturopathic physicians attend regionally accredited schools
with professional accreditation by the CNME, recognized by the U.S.
Department of Education, similarly to the professional accreditation
of MD programs by the LCME.
Legitimate naturopathic medical schools are listed in the
Princeton Review 'Best Medical Schools' guide, just as all legitimate
conventional and osteopathic medical schools.
The AMA does not hold the monopoly on providing health care, its
historical efforts notwithstanding.
Obviously schools do not teach inner wisdom, but I would not dismiss
it facetiously out of hand.

Posted by: Hermano | June 10, 2008 4:14 PM

"Obviously schools do not teach inner wisdom, but I would not dismiss
it facetiously out of hand."

Why not?

Posted by: PalMD | June 10, 2008 4:16 PM

@frog,"Just like public health has done more to help health than all
the MD of the last century ..."

Public health measures are entirely based in scientific medicine. Can
you be any more ignorant?

Posted by: Joe | June 10, 2008 4:16 PM

Dr Ted, could you provide links for us? In my admittedly too-brief
research, I was unable to find any clear info on accreditation of
ND's, educational requirements, course content, etc.

I would like to see it written that they actually receive a "MD plus"
sort of thing, and what that "plus" represents---evidence-based med,
or wishful thinking woo.

Posted by: PalMD | June 10, 2008 4:18 PM

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