I remain skeptical of NDs, and frankly it frightens me somewhat that an ND can actually prescribe medications. The issue is not about preserving knowledge or saving the field of traditional medicine. The issue, in my opinion at least, is ensuring that people have enough knowledge and experience working with patients to ensure that 1) scientifically accurate, correct, and beneficial information is being provided to patients, and 2) that the practitioners are competent enough to accurately diagnose conditions and treat them effectively - including with traditional medicine and referral for more radical interventions if necessary. My experience doesn't indicate to me that that is universally or even mostly true, but I admit that it may just be the NDs that I've happen to interact with by proxy.

And just to be clear about my position - I have no qualms with alternative medicine or any other "non-traditional" therapies. In my own practice, I would much rather prefer that patients do almost anything possible to correct issues than prescribe a medication. We see medications as completely harmless, but the reality is that you're introducing something exogenous into a complex system. Whether we can measure them or not, I'm sure there are adverse effects occurring. I fully support "natural" remedies that have been demonstrated to have efficacy and improve either quality of life or long-term outcomes. St. John's wort, as an example, has been shown to be as effective as first-line SSRI therapy in treating mild to moderate depression. In Germany, it's actually the first line of treatment. That makes sense to me: there's a lot of evidence supporting its use, its safety profile is relatively well-known, and, all things considered, it's relatively harmless. If a patient comes in with mild depression, I will absolutely suggest a trial with St. John's wort for a few weeks prior to switching to a SSRI unless I'm at all concerned about the person. Red rice yeast for hyperlipidemia, cayenne pepper for diabetes, and many other "alternative" therapies exist that have been shown to be effective. That's the key to me: if we're going to peddle something, let's at least minimize the chance that it's complete bullshit or, at the very least, do the work necessary to make sure that the intervention is having some kind of effect. If that can be shown (even if it's not understood) and the safety profile of something is relatively known, then I have no issues with alternative medications.

My concern with NDs is two-fold: 1) it isn't clear to me what actual "training" NDs have completed, making it difficult for me to actually assess what they should and should not be doing, and 2) the quality seems to vary widely. How does a ND learn about the diagnostic process and develop clinical reasoning? What is their clinical training? Do they know how to do a basic physical exam? There are some NDs that understand their scope of practice, know when "traditional" medicine is indicated, and will integrate their practice within the context of "traditional" medicine. There are others - many others, if the number of times I've heard shitty and outright dangerous advice from patients provided by NDs is indicative of anything - however, for whom those aren't concerns, and, instead, it becomes a crusade against "traditional" medicine and some kind of pseudophilosophy that claims that some kind of herb extract or acupuncture will cure cancer. If a patient wants that kind of treatment instead of "traditional" medicine, then by all means they should pursue whatever remedies they'd like. My ire is raised, though, when they dispense really questionable advice or refuse to refer when they really should. NDs and other pseudomedicine practitioners (chiropracters, for example) are quick to take on the title of "doctor" - and to capitalize on the trust and authority that title engenders, particularly in healthcare - but, at least from my perspective, they are hardly linked at all to their more traditional MDs and PhDs which are generally rooted more in scientific observation and explanation over hand-waving.

And while I share your interest in placebos, I think it's important to remember that placebo effects really aren't the basis for a general treatment strategy. Multiple studies have demonstrated that while placebos typically result in improvement in patient-reported outcomes, there is no statistical difference between placebo and no treatment in most cases. I think the placebo effect is rightly relegated to the back pocket of physician tricks: something to be tried if there's nothing else to do, but I don't think the evidence supports using placebos dilly dally (though one might make the argument that the harm of placebos is effectively zero, so why not give it a shot). It's also important that patients understand that while placebos may make you feel better, they are almost certainly not doing anything to treat organic disease. In other words, your sugar bill is probably not going to cure your IBD, cancer, hepatitis, or other serious condition beyond possibly making you feel better. That is, of course, extremely important, but I've found that people's knowledge of the body and medicine is, on the whole, pretty poor, and people may think they're "being cured" simply because their symptoms are improving.