The case against Naturopathy (in non-licensed states)

Before I launch into this, I need to make a few things clear.

First, I'm not one of the lunatics that runs Quackwatch, coming out against everything non-pharmaceutical, claiming anything but drugs or surgery to be a scam (if anything, drugs and surgery are also a scam of sorts in their own ways; they do not have the solid research backing everyone thinks they have, nor are they as safe or successful as the establishment claims they are).

So anyway...second, I'm not a narrow-minded person. Without revealing too much, you already know I'm a chiropractor in Texas. My mind is as open as the next New Ager; I believe in auras, Indian chakras, healing with crystals, ESP, extraterrestrial contact, energy fields, polarity therapy, aromatherapy, and about everything else that's remotely possible.

Third, I'm not simply dashing a segment of my competition by which I feel "threatened", because I'm not and I don't. Why? Naturopaths are not exactly my competition in the first place. I think they try to be, but they lack the legal scope.

And last, this editorial is in NO WAY directed at the licensed Naturopathic Doctors (NDs) in states that recognize and license them. They are licensed physicians in their states and their licensing grants them certain rights and responsibilities in regards to acting as a type of physician.

Every healthcare practitioner who is not an MD (or a DO) is bound by annoying invisible handcuffs known as "scope of practice". It serves as a constant reminder that we are somehow second-class citizens, beneath an MD/DO, and that we're permitted to exist only because they haven't seen the need to quash us yet. This goes for nutritionists, chiropractors, dentists, massage therapists, physical therapists, nurse practitioners, physician's assistants, pharmacists, acupuncturists, the list goes on.

Naturopaths in Texas don't have a scope of practice, per se, because they're not regulated or licensed in any way in Texas. Texas doesn't recognize them as physicians, so they obviously can't diagnose or treat any conditions, nor can they order any kind of diagnostic laboratory testing such as blood tests. This really kind of reduces them to consultant status, at best. What can they really do, anyway? They can meet with a client (not "patient"), have them fill out questionnaires, listen to their problems, and suggest they might try this or that supplement. Some medical-grade supplement companies will allow the ND to distribute their products; others won't, insisting that the practitioner hold some kind of license.

Since they can't order testing, this forces Naturopaths to resort to methods of testing that aren't diagnostic. This includes methods of "testing" in which "the jury is out", says a colleague, such as attempting to analyze the irises of the eye to obtain clues about what might be going on in the rest of the body, or having the client hold a vial of a substance while holding their arm out straight, resisting against the Naturopath's push. Apparently, if the client's arm goes weak, the substance is reactive.

This is all well and good, and in fact, several of my colleagues, licensed chiropractors, practice this way. It's efficient, and their specific training in this technique makes it more meaningful. I don't have any doubt that "muscle-testing", as it is known, works. The operative concept here is, what kind of training did the practitioner have? Three things my muscle-testing expert colleagues insist upon is, 1) it takes a while to get good, 2) you have to be really careful not to let your own preconceived notions (conscious or not) influence your findings, and 3) you really should have quantifiable blood or saliva tests to back up your findings.

They also say, that non-diagnostic testing is not a substitute for diagnostic testing; muscle-testing tells next to nothing about someone's blood or saliva chemistry, which is the real determining factor of their physiology. Muscle-testing is efficient (although non-specific) for reactions to certain substances. Meaning, just because your arm went weak when you touched your liver doesn't tell us anything about your actual ALT. Touching your thyroid doesn't test for TSH, T4, T3, or thyroid autoantibodies, you know?

Same thing with iris examination, known as Iridology. It's not that there's nothing to it, but it doesn't tell us much. A dentist who was also a naturopath (from some online college I'd never heard of, which is another problem we'll address later) looked in my iris and told me I had a colon issue. He probed my clothed abdomen and claimed I had polyps. Naturally I was a little concerned because polyps do indeed run in my family, and my grandmother had colon cancer. Problem is, this kind of examination does NOT equal a scope. My colon may not have been 100% rosy, but come on--I was 26 at the time; no need to freak me out until further testing was done.

I have no problem with Naturopaths acting as consultants. What I do have a problem with is when they try to take the place of licensed doctors (medical doctors, chiropractors, or osteopaths), not doing anything to dispel the client's misconception that they are a substitute for licenseholders. I also take issue with any time they try to identify a problem using non-diagnostic testing, downplaying the fact that they cannot order quantifiable industry-standard testing, and I get concerned when they "find" something and neglect to refer the client to someone who can order real testing.

A patient I'd started to work with but hadn't seen in a while came into my office one afternoon, claiming she'd been to a Naturopath, and started unloading a shopping bag of supplements, bottle after bottle, onto the counter. They were from a company I'd never heard of (and I'm familiar with all of the major high-end medical-grade supplements, as well as the store brands) and had non-descript names such as "Adrenal Support" and "Thyroid Formula".

Me: "So how'd your adrenals test? Too high or too low?"

Patient: "Oh I don't know. She [the Naturopath] didn't get into that. She just said they were 'off'."

Well, lemme tell you something about adrenal glands. They put out cortisol that hormone we know as the "stress hormone". They can function too high and put out too much cortisol, or they can function too low and put out too little. Each scenario carries with it its own set of issues and must be dealt with in markedly different ways. You have to know which scenario applies; you don't want to apply the wrong remedy! Well, since Naturopaths can't test adrenal gland function, they never know what's going on. This is the same patient to whom I had recently suggested the bonafide accepted adrenal test and she had declined. Ha. Hope for her sake the Naturopath guessed correctly.

It was both a plus and a minus that she had come to me to seek my opinion on all this. It was good that she regarded me highly enough that she valued my opinion, at least enough to come into the office to ask me (not that she did much with my gentle-but-honest viewpoint after that; maybe because I softly asked a few hard questions, ones she may not have wanted to contemplate, but hey, my conscience is clear and that's how I sleep at night).

The part of her appearance at my office that was a headache was that she had already been to this practitioner and had already plunked down $75 on supplements solely on the Naturopath's word that she "needed" them without having anything to back up the claim. My patient didn't know exactly why she was being given these. I have my own theories and they have more to do with financial accounting than biochemistry. So, the decision had been made. And now my patient was in my office, unannounced, attempting to ask my educated opinion without compensating me for my own time. I enjoy and cherish each patient, but I tend to shy away from working with those who are not serious enough to schedule ahead of time. A quick question is one thing, but this lady lingered at my desk for at least a half an hour. I wanted to ask her why she sought my opinion; it was clear that nothing I said was going to make a difference, as her mind was already made up. So why waste her time and mine?

The scariest part about Naturopathy in unlicensed states (such as this one) is that ANYONE can call themselves a Naturopath, whether they went to school or not. They could've done the right thing and gone to a bonafide, legit, regionally-accredited school and obtained a real degree and license in the state they went to school in. Or, they might've taken all of their courses online from a decent internet-based school (not accredited, no license at all, but at least semi-sound information). Or, they might've taken courses online from a shadier diploma-mill-type "school" (same scenario, scantier information). Or perhaps, they simply woke up one day and said, "I'm going to read some books and make me a business card that says 'John Doe, ND'." And believe it or not, Door Number 4 is perfectly legal. Yes, you can hang a shingle in most unlicensed states and call yourself an ND tomorrow. With NO training.

If you do decide to see someone who calls him/herself an ND in an unlicensed state, there are ways to avoid getting screwed; it can be done.

1) Question them extensively about where they went to school. Write down the name of the school. Look it up online. Make sure it's a brick-and-mortar school in a state that licenses NDs.

2) If they claim to be state-licensed, don't believe them, because there is no such thing. Hopefully they'll add the caveat that they're *Washington*-state (or New Mexico or Arizona or some other legitimately licensed state) licensed. Sometimes this takes a little digging, because they don't want to admit upfront that they're not TEXAS-state licensed.

3) See a Texas-state licensed doctor (preferably DC or DO, as most MDs aren't necessarily very open-minded and can carry a too-healthy dose of ego with them) who will order the laboratory testing necessary to confirm or further investigate the NDs non-specific test findings.

4) Don't let the Naturopath diagnose your condition or claim to treat it--because they can't.

5) make sure they're not JUST trying to sell you supplements. Most complementary and alternative medicine (CAM) practitioners utilize supplements as a method of helping your problem, but they should be able to tell you without a doubt WHY you need that particular supplement, and they should be able to point to genuine, peer-reviewed research that shows the ingredients in their supplements are effective for your ailment. It should also go without saying that your supplements should have unmistakable, legitimate standard Nutrition Data and full ingredient labels on them! Don't EVER accept a bottle with incomplete, non-standard labeling!

Don't be fooled - by the MD OR the ND. :)