​This past week, the Massachusetts Senate passed S. 2335 (a re-do of House Bill 1992 and Senate Bills 1205 and 2148, which it now supplants), allowing naturopaths to practice legally in Massachusetts. This will be, by my count, the 11th legislative session in which a naturopathic practice bill has been introduced. A bill actually passed one year, thanks to some questionable legislative shenanigans at the end of session, when the bill, under any fair interpretation of Massachusetts legislative procedure, should not have been considered. Fortunately, it was vetoed by the governor. S. 2335 now moves to the House Ways and Means Committee.

S. 2335 gives naturopaths a broad scope of practice. The Senate apparently fell for the naturopathic lobbying line that naturopaths can prevent, evaluate and treat illness with means that "support, stimulate or supplement the human body's own natural self-healing processes." This is, of course, simply vitalism, the long-discredited pre-scientific notion that some incorporeal force controlled human bodily function. What the bill actually does is allow poorly educated and trained "doctors" to diagnose any patient with any disease or condition and treat those patients with an array of ineffective and potentially dangerous remedies. The bill states that naturopaths may not "assume the character or appearance of a primary care provider," but then turns around and gives naturopaths the same scope of practice as a physician by allowing them to diagnose and treat any patient who walks in the door, limiting only the means by which they may do so.

Naturopathic education and training are woefully inadequate to the task. Family practice doctors enter practice with four years of medical school and 3 years of residency.(You can see a chart comparing medical and naturopathic education and training here, showing that family practice doctors have a whopping 15,000+ hours more education and training than naturopaths.) Naturopathic "medical" schools do not offer nearly that level of education and training, yet any patient can see either practitioner, no matter how ill he is or obscure his disease might be.

Naturopaths like to say they will refer patients who are beyond their skill set. But how could they possibly know that the patient has a condition they don't know how to properly diagnose and treat if they've never seen a patient with that particular problem?

Britt Hermes, herself a former naturopath, has detailed the inadequacies of her education and clinical training at Bastyr, supposedly the premier naturopathic program in the U.S. in two posts on Science-Based Medicine:

ND Confession, Part I: Clinical training inside and out

ND Confession, Part II: The Accreditation of Naturopathic "Medical" Education

Hermes's own blog, Naturopathic Diaries, provides a less sanitized, and more realistic, look at naturopathic practice than the naturopathic lobbyists would like the legislators to see.

In fact, Naturopathic Diaries looked at actual naturopathic practitioners in Massachusetts and found a cornucopia of pseudoscience and quackery:

Ozone and ultraviolet light therapy

Homeopathy

"Alternative" cancer treatments

Biotherapeutic drainage

Bogus lab tests (also here)

"Revitalized" water

Electro-dermal screening

Orac looked at the websites of Massachusetts naturopaths and also found "serious woo," such as a claim by the former president of the Massachusetts Society of Naturopathic Doctors that homeopathy is effective for food poisoning, among other things. Orac found another Massachusetts naturopath who claims he can "clear the blood and lymphatic circulations of impurities" with a footbath. This is just a small sampling of the many bogus treatments and fake diagnoses naturopaths use in their practices, like adrenal fatigue, chronic candidiasis, and imaginary malfunctioning thyroids.

Unfortunately, their ability to diagnose these nebulous conditions, which are not recognized as legitimate by other health care practitioners, will be greatly facilitated by the authority this bill gives them to order clinical and laboratory procedures "to evaluate injuries, illnesses and conditions in the human body." This will permit naturopaths to order the bogus tests they use in their practices, such as live blood analysis and salivary tests for hormone therapy, or in-house use of bogus diagnostic devices like electro-dermal screening, all of which were recently found to be without validity in an Australian government report. An Endocrine Society Scientific Statement, just released, confirms that there is no evidence that salivary tests for hormone therapy are reliable and that compounded bioidentical hormones have serious safety issues. Both are standard in naturopathic practice.

S. 2335 will legalize naturopathic use of dietary supplements in the treatment of disease (and selling them to patients) even though there is currently no good evidence that any dietary supplement is safe and effective for treating all but a handful of conditions. It will also permit the use of "natural hormones" like "bio-identical hormones" and glandulars, which are dessicated animal organs. Neither of these is considered safe or effective for any condition. Naturopaths will be able to prescribe and sell homeopathic remedies, which do not, and cannot, work.

It is ironic that this bill would pass the Senate on the heels of yet another survey showing naturopathic students are anti-vaccination, even as measles outbreaks due to lack of immunization alarm public health officials. The survey results are unsurprising given the fact that naturopaths are virulently against immunization. Unfortunately, their patients pay for this: 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 S.2335 requires a naturopath to refer patients under 18 to a primary care physician if the patient has not been immunized.

As recently detailed in a STAT report, naturopathic lobbying efforts are being funded by dietary supplement manufacturers and companies that sell dubious tests to "diagnose" the fake diseases naturopaths have invented. Amy Rothenberg, a naturopath featured in the article, is the perfect exemplar of why naturopathy should not be legalized. She and her husband, Paul Herscu, 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 1800s. 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. This is in spite of the fact that homeopathy has been thoroughly discredited, most recently in an exhaustive review of the evidence by the Australian government. Rothenberg recently testified in favor of homeopathy before the FDA, claiming that its purported mechanism of action is hormesis, which simply goes to show she doesn't understand biology sufficiently to know any better.

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"

This poor education and training and lack of a standard of care predictably results in some horrifying treatment of patients, revealed only when they do not realize someone is watching. David Gorski, MD, and Orac give the chilling details of conversations naturopaths have among themselves discussing treatments for cancer, such as a drug not approved by the FDA and high dose vitamin C, both given IV, as well as mistletoe extract, plus the use of ozone therapy, black salve, homeopathy for bipolar disorder and IV hydrogen peroxide for other illnesses. You can also "overhear" their discussions of their anti-vaccine ideology and how they ignore evidence-based medicine. This sort of ignorance can have tragic results, as demonstrated in the death of a Canadian toddler whose parents sought a licensed naturopath's advice when he contracted meningitis.

Because S.2335 permits naturopaths to regulate themselves, via a "Board of Registration in Naturopathy" ("registration" in Massachusetts is comparable to licensing in other states), it is highly unlikely that such practices would be curbed. The Board would be composed of two naturopaths, one physician, one pharmacologist, and one public member. The physician must have experience working with naturopaths. Unfortunately, this can lead to the appointment of an "integrative" physician sympathetic to naturopathic practices who might be less effective in supporting science (or even evidence) based medicine.



Massachusetts legislators may want to think twice about the burden on the public purse if naturopathic registration passes. The position of the American Association of Naturopathic Physicians (AANP) is that, once naturopaths are licensed or registered in a state, their services must be covered under the Affordable Care Act. Does the state really want to pay for care from practitioners who ignore evidence-based medicine?

It is the goal of the AANP that naturopaths be licensed as primary care physicians, including full prescription privileges, in all 50 states, and they will keep coming back to the state legislators seeking practice expansion once they get a practice act passed. You can bet that, if this bill passes, naturopaths will be back before the Massachusetts legislature, year after year, until they get what they want. This is their pattern in every state in which they've gained licensure or registration.

As Steve Novella, MD, said on the Neurologica blog:

"Essentially the states are giving naturopaths a license to defraud the public, to pretend to be doctors when they are not, and to inflict upon the public a witches brew of medical pseudoscience that is at best worthless".

Rather than legitimizing naturopathy, Massachusetts should be acting to shut down the currently practicing naturopaths who are clearly practicing medicine without a license and fleecing the public.

For further information on naturopathy

Specific 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

Other information:

Expert Testimony on Naturopathy and the Licensure of "Naturopathic Doctors"



Disingenuous: Deconstruction of a naturopathic white paper

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

Wild west: tales of a naturopathic ethical review board

The price of a naturopathic education

What does ND mean?

Keep naturopathy out of the VA!

Naturopathic Diaries

Oppose Naturopathic Licensing

To contact House Ways & Means Committee Members:

House Ways and Means Comm.

Brian S. Dempsey House Ways and Means Chair (D) This email address is being protected from spambots. You need JavaScript enabled to view it.



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