My View • No residency? A plethora of diluted remedies? No way that's real care

Regarding the Tribune story 'Paging Dr. Alternative' (April 1), naturopaths should not be primary care providers or prescribe medications.

Their training and experience in biologic sciences and clinical medicine are inadequate. Both clinical training during school and postgraduate training is minimal compared to the education and training of medical doctors and doctors of osteopathy. There is no residency for most naturopaths; after graduation they can practice.

I would be disturbed if medical students were allowed to go directly into practice without postgraduate training, yet that is the norm for a naturopath. In contrast, three years of training are required after medical school to be a family practitioner, internist or pediatrician. It is estimated that it takes 10,000 hours to become expert in an area, which is about the time spent in a three-year residency.

Even if naturopaths could find residencies and get the needed experience, in the end it is the underlying paradigm of naturopathic education - pseudoscience and magic - that precludes their functioning as primary care providers. No, not Harry Potter, although when the state approved prescribing privileges for naturopaths, I wondered if Salem had been hit with a Confundus charm.

Fundamental to the naturopathic curriculum is the teaching of magic: Homeopathy. Water therapy. Reiki. Energy Therapy. Craniosacral manipulation. Acupuncture. All are based on a supernatural or pseudoscientific understanding of reality with no basis in known anatomy, physiology, chemistry, biochemistry or physics. They offer nothing beyond a meager placebo effect.

Two representative examples:

A popular homeopathic nostrum for influenza is Oscillococcinum. The heart and liver of a muscovy duck are allowed to liquefy for a month and are mixed with water, which is then sequentially diluted 200 times. This is such a high dilution that the final product contains not even one molecule of the original liver. This is then given to treat influenza, a potentially lethal infection.

Homeopathic nostrums are pure water, claimed to be imprinted with the 'memory' of a substance and to become stronger the more it is diluted. I would not go to a bartender who thought that the more the martini was diluted, the stronger it became, much less a health care provider who prescribed medications using that principle.

Yet homeopathy, a ritualistic form of magic, is a mainstay of naturopathic training. Our local naturopathic school provides 72 hours of pharmacology education, but twice (144 hours) as much training in homeopathy. Naturopathic students may elect additional courses to broaden their knowledge: 144 hours in homeopathy, 36 hours in qi gong, 26 hours in Aruyveda, 24 hours in 'energy work' and 12 hours in colonics (enemas).

No electives are available in pharmacology. Not a good foundation upon which to prescribe complex medications, much less to function as a primary care provider.

There may be more things in heaven and Earth than are dreamt of in my philosophy, and the above 'therapies' may represent advances in our understanding that will garner innumerable Nobel prizes for their discoverers. Or, more likely, they represent pre-scientific, pseudoscientific, magical thinking that can kill.

I remember vividly a young woman whose lower leg had developed wet gangrene from a progressive muscle tumor. Her leg was black, bleeding and smelled of decay. She refused antibiotics and surgery in favor of naturopathic treatments. She died. If she had had an amputation, she would be alive today.

Yes, I am aware of the number of health care-associated deaths in the U.S. But a difference between MDs and NDs is that hospitals are successfully using science to change practice to prevent those deaths. Magic never changes, never improves, never alters its practice to improve care.

I have been in practice for 20 years. Health care in the U.S. has numerous problems for which I have no solutions, but that is not a validation of naturopathy. Naturopathy has to stand or fall on its own principles and practices. If there were a shortage of life guards, I would not hire those who believed in walking on water. If there were a shortage of pilots, I would not fill the positions with those endorsing levitation. If there is a shortage of primary care providers, we should not fill the void with practitioners who follow the pseudoscientific magic taught at naturopathic schools. People deserve better.

Mark Crislip, MD, is an editor for the Science Based Medicine blog and the producer of the Quackcast, voted 2009 best Health and Medicine podcast,

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