Your perception is accurate-ish. Here's the creed. You'll notice some "trigger language" in there, including the phrases "manipulative therapy" (chiropractic, by any other name), "homeopathy" and "acupuncture." It will not surprise you in the slightest to know that these three aspects of naturopathic medicine are the causes of perpetual internecine warfare. When my wife graduated in 2009, she was required to take 3 quarters of homeopathic medicine in order to graduate. She was required to take one quarter of acupuncture. The same school now requires a weekend course in homeopathy and no training in acupuncture. The basic dilemma is "alternative medicine" generally includes "all the shit you can't get at the hospital" and it's taken some real combat to bring the profession around to the reality that just because you can't get it at the hospital doesn't mean it's good. Something that complicates matters is the consensus opinion on placebo. Ask Western medicine if placebos have value and they'll say no - obviously, it's no better than sugar pills. This ignores the fact that the placebo effect is still an effect and if it's an effect with no side effects, it's well worth exploiting. This is generally the point where the chest-thumping "skeptics" decry the charlatans that are charging an arm and a leg for "sugar pills" without recognizing that there are very, very few sugar pills that cost more than a few bucks. Nobody ever got rich on homeopathics. The 800lb gorilla in the field, Boiron, earned less money last year than Pfizer spends on a single Superbowl ad. I'll state this here and now for the record - homeopathic remedies fuck me up. There's no logical basis to their function. I know damn well they're sugar pills with magical mojo infused in a truly comical fashion. Nonetheless, Bach flower essences calm my ass down and a goddamn homeopathic remedy once gave me a panic attack. Even knowing that there's a 99.99999999% probability that it's pure placebo, I'm not immune to that placebo. And considering there are no drug interactions with sugar pills, I acknowledge the occasional value of sugar pills. That's why /r/skeptic wants to burn me at the stake. I'll go one further - in Washington, my wife can prescribe drugs up to Schedule B. This is not because naturopaths want to prescribe drugs, but because the state legislature determined (correctly, in my opinion) that if a naturopathic doctor is going to have the ability to wean a patient off prescription drugs as part of their treatment, they bloody well better know enough about said-same drugs to be able to prescribe them. yet the consensus opinion is that knowledge should be protected and reserved to the degrees that make the skeptics feel comfy lest too many people, I dunno, know too much stuff or something.
Sometimes it doesn't even take sugar pills. There was a study once that showed that stroke patients recover faster and more fully if their hospital room has a window, and further, if outside that window stands a tree. The problem with the skeptic types is that they confuse science and dogma, forgetting that science doesn't mean "let's find out the 'truth' about X, Y and Z," but rather, "Can we measure the effect of such and such on X, Y and Z?" Biochemically speaking, we have no idea wtf hope, love and positivity are, but fuck if they don't help people. Edit: And I hope we never do find out wtf they are, because you know Pfizer and the boys will all try to monetize it even though the real thing is free. But look up studies on oxytocin; people are already trying to tell you that the love you feel is purely biochemical.
Dan Ariely quotes a study in which two groups of people are given placebos. One of them is told the pill normally costs $0.20. The other is told the pill normally costs $9. Guess which one is more effective? There are cultural aspects, too. Germans react well to placebo injections. Americans react well to placebo pills. Some other culture reacts well to placebo salves. Go figure.
Placebo exorcisms in rural India have more efficacy against depression and anxiety than talk therapy does in Denmark
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.
Which is why, in order to get a license to practice, my wife had to pass the medical boards and the naturopathic boards. For the medicine she's allowed to practice, she's held to the same standards as MDs. It varies per state. Many states don't license at all, so anyone can call themselves an ND. In California my wife is allowed to call herself a doctor, but not a physician because of existing liability and insurance law. In Washington she can be a part of HMOs and take insurance and be referred out to like any other specialist. On the other hand, buddy of mine lost his best friend to a "naturopathic doctor" in Hawaii that tried to treat his cancer with herbs and well-wishing. The twist? He was also an oncologist. See previous statement about state law. There are seven schools that teach to the test that the AANP hammered out with the AMA. There are quite a few that don't. Those seven schools are the only programs that will get you a license in a licensed state. Everyone else is a charlatan. A year of gross lab, two years of residency, a year of pharmacy, O chem, microbiology and all the rest. Same as an MD. Three mandatory years in clinic seeing patients while still in school does the trick. So you're in Germany, yeah? I have absolutely no idea what the regulatory constellation is out there. I only know the US, some of the UK and Australia/NZ. I know that the UK, Aus and NZ are a lot more lax by comparison. Yup. And those are the ones that make the headlines. "Parents refused treatment for their daughter; preferred homeopathy" and the like. Never a happy ending for anyone. My wife had a bad case of eczema her first year. She had an instructor that decided to treat it homeopathically. It got really really bad - which excited the hell out of the homeopath because she was having a "healing crisis." Never mind that her hands looked like she'd been soaking them in gasoline overnight or that she couldn't make a fist without crying. That was Reality Intrusion #1 - I told her that no "healing crisis" was worth this and made her professor give her a steroid cream. Reality Intrustion #2 was a bladder infection they tried to treat with cranberry juice and herbs well past the point where it was clear it wasn't doing anything. She ended up with a Cipro prescription. Has she treated bladder infections with cranberry juice and herbs? Yes. but not all of them. Pragmatism is important in any branch of medicine. The argument in the US is since you can get a doctorate in philosophy, you can get a doctorate in homeopathy. But unless you've got an MD, you don't get to call yourself a "physician." And I think it's important to point out that the overwhelming majority of patients seen by naturopathic doctors in the US tend to be the "worried well" who likely don't have anything physically wrong with them to begin with. Establishing that this is in fact the case through blood tests and other empirical evidence is important... but beyond that, statistics goes completely to shit when your n=1. That, more than anything, is what I believe has led to the rise of alternative medicine in the United States if not the world: the fundamental belief that patients will revert to the mean if given long enough, rather than recognizing that anyone who has seen a dozen specialists without finding relief is, by definition, a corner case.
So wouldn't you rather have your sugar pill dispenser be fully trained to recognize and refer IBD, cancer, hepatitis or other serious maladies to a specialist who can treat them effectively? My wife much prefers delivering babies to naturopathic care. For the former, she's got "we're having a baby and there's a 4 in 5 chance that it'll be totally normal! Take our money!" For the latter, she's got "I've seen half the specialists in the LA basin and none of them have been able to help me. Your turn." The only saving grace of the naturopathic patients is that they've long since conflated "make me better" with "make me feel better" and by the time they've been told there's nothing wrong with them by six specialists, someone who listens and tells you to get more sleep goes a long way towards empowering you towards your own health care. But she is nobody's PCP. She does well child visits, she deals with chronic conditions, and she practices adjunct care in support of oncologists, endocrinologists, psychotherapists, etc. And I guarantee you, the more education you have about what you don't want to get into, and the more professional stakes you have on the line for getting in over your head, the more incentive you have for practicing what you know.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.
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,
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 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
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
NDs and other pseudomedicine practitioners (chiropracters, for example) are quick to take on the title of "doctor"
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.
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.
Thanks for all this info. Preach. the placebo effect is still an effect and if it's an effect with no side effects, it's well worth exploiting.