Michigan House Bill 4531, if passed, would give naturopaths one of the broadest scopes of practice in the U.S., essentially equaling that of a family practice MD or DO. The bill made it through all the necessary House committees and is now before the House for an initial vote determining whether it will proceed further in that body. If it passes there, it will move to the Senate and its committee process.
Most naturopathic licensing bills fail, even in those states where attempts are made year after year. Michigan is no exception. Both David Gorski (a Michigan resident) and I discussed the previous licensing attempts there. In the two states where naturopathic licensing or registration has succeeded in the last few years, they have been able to get only a much more limited scope of practice than the full primary care scope they desire. For example, in Colorado, there are severe limitations on naturopaths’ seeing pediatric patients. They must disclose they are not physicians, recommend to parents that their children have a relationship with a licensed pediatric practitioner, and give parents the CDC-recommended vaccination schedule. All this is to thwart their efforts to talk parents out of vaccinating their children by giving them “balanced” information that is actually full of anti-vaccination dog whistles.
In Maryland, where naturopaths are regulated by the Maryland Board of Physicians, they cannot call themselves physicians or claim to practice primary care. They must have a collaboration and consultation agreement with an MD or DO and attest to the Board that the ND will “refer patients to and consult with physicians and other health care providers.” NDs must also have patients sign a consent form stating that the ND’s practice is limited to the scope of practice allowed by law. They cannot deviate from what is termed “safe care of patients” whether or not actual injury to a patient is established.
If passed, HB 4531 would be a radical departure from that trend. This newfound success in moving the ball forward may be due to an influx of funds from Emerson Ecologics, a company that sells dietary supplements and homeopathic remedies to naturopaths for resale to their patients. The company also sells the sort of dubious diagnostic tests used by naturopaths in their practice. For example, they offer a test for “adrenal stress” (to discover, not just “adrenal fatigue,” but actual “exhaustion”) and a saliva test for hormone levels as an indicator of the need for “bio-identical hormones.” (Neither the test nor “bio-identical hormones,” which is actually a marketing, and not medical term, are recommended in evidence-based medical practice.) In March, Emerson Ecologics announced a “grant” to the Michigan Association of Naturopathic Physicians (MANP) of $10,000 to support the effort to obtain full licensure for naturopathic doctors in Michigan.
The MANP is no stranger to corporate funding from companies that would benefit from their licensing. It is indeed odd, and hypocritical, that we at SBM, who accept no money from pharmaceutical companies, are referred to as “Big Pharma shills,” but no one hears a peep about the conflict of interest when naturopaths openly accept contributions from companies with whom they share a symbiotic relationship.
We’ve catalogued naturopathic pseudoscience here on SBM many times. Here, for example, is David Gorski’s excellent description of naturopathic practice:
naturopathy is a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. As a result, typical naturopaths are more than happy in essence to “pick one from column A and one from column B” when it comes to pseudoscience, mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicinethat you can imagine.
If you want to dig further, there’s Scott Gavura’s meticulous analysis of naturopathic practices in his wonderful Naturopathy vs. Science series, Britt Hermes’s Naturopathic Diaries blog, the information on the Oppose Naturopathic Licensing website, as well as numerous entries on Quackwatch and its affiliated website, Naturowatch.
First, I’ll summarize HB 4531. Then, in contrast to the dog-and-pony show naturopaths are no doubt putting on for Michigan legislators, we’ll look at what the good folks in Michigan can actually expect from their licensed naturopaths if this bill becomes law, as revealed by naturopaths who are now practicing in other areas of the country as well as in Michigan.
House Bill 4531
“Naturopathic medicine” is defined in HB 4531 as
a system of practice that is based on the natural healing capacity of individuals for the diagnosis, treatment, and prevention of disease.
As David said in his post on the previous bill,
The wag in me can’t help but point out how stupid this definition is. Let me just put it this way. Science-based medicine relies on the natural healing capacity of individuals for the diagnosis, treatment, and prevention of diseases. Think about it. Setting broken bones would be useless if the body weren’t able to heal itself naturally. Surgery itself relies on the ability of the body to heal itself; otherwise cutting into the body to rearrange its anatomy for therapeutic intent would be the gravest of folly. The very definition of naturopathy is a false dichotomy between conventional medicine and “natural healing.”
Actually, they likely mean the kind of “natural healing capacity” that is vitalism, a prescientific concept at the core of naturopathic philosophy. The idea behind vitalism is that there is some incorporeal healing force inside our bodies acting independently of the real natural processes actually doing the work, like chemistry and biology. This was debunked long ago.
In any event, HB 4531 gives naturopaths the authority to diagnose, treat and prevent disease in any patient, of any age, with any disease or condition. This is a frightening concept, considering how ill-prepared they are by their education and training. Fortunately, we now know far more about that subject, thanks to the inside scoop provided by Britt Hermes, who went through the whole process herself and has been brave enough to tell what she knows. In addition to coursework devoted, in part, to nonsensical subjects like homeopathy, she breaks down their clinical training to reveal its gross inadequacy.
As Britt notes, the only clinical training naturopaths get prior to going into practice has to fit into their 4 years of naturopathic “medical” school, leaving them a mere 15,000+ hours short of the training family practice physicians must undergo. Here, they have cleverly left out of HB 4531 any claim they are capable of providing primary care (a claim that they cannot support with any objective evidence) perhaps to thwart efforts to make this sort of revealing comparison, while helping themselves to the same scope of practice anyway. Their lack of pharmacology education and training is particularly concerning in states where naturopaths (as here) lobby for prescribing privileges.
Yet HB 4531 falls for the false notion that naturopathic education is sufficient for this broad scope of practice, even though the whole closed-loop system of naturopaths teaching naturopaths in naturopathic schools accredited by an organization totally run by naturopaths, a system that operates wholly outside mainstream American higher education. Following that, they sit for an exam created and graded by naturopaths – an exam that has never been reviewed by anyone outside the closed loop. (Validating it for having content that actually reflects what naturopaths were taught doesn’t solve this problem. We need to know what they are actually tested on.) Then, they go straight into practice, no residency required.
Despite these deficiencies, HB 4531 would allow naturopaths to call themselves “physicians” and to
- Order and perform lab exams for diagnostic purposes
- Order diagnostic imaging studies
- Prescribe (and, of course, sell) dietary supplements and homeopathic remedies
- Use hot or cold hydrotherapy (including colon hydrotherapy)
- Use “electromagnetic energy”
- Perform minor office surgery, including “obtaining specimens to diagnose, assess, and treat disease” (such as an excisional biopsy, another scary thought)
- Other naturopathic therapies approved by the Board
They will also be able to prescribe drugs, including controlled substances, if the drugs are on a naturopathic formulary. This formulary would be devised by a Formulary Council, on which, fortunately, in addition to two naturopaths, there will be two pharmacists and one MD or DO physician.
They will be able to use all routes of administration, including rectal, vaginal, transdermal, intramuscular and intravenous. (Especially disturbing in light of their willingness to pump patients full of things like Myers cocktails.)
Naturopaths will be regulated by both the Michigan Department of Licensing and Regulatory Affairs and a Board of Naturopathic Medicine. The Board would be composed of three naturopaths, two MDs or DOs, and two public members, leaving open the unfortunate possibility that they will engineer the appointment (by the Governor) of sympathetic public members and outflank the MDs/DOs. Michigan would be foolish to rely on a naturopathic board to assist in regulating naturopathic practitioners. Naturopathic Boards in Arizona and California have endorsed the most egregious quackery in service of the naturopaths they are charged with regulating.
How naturopaths really practice
I trust the naturopaths sold Michigan legislators on the idea that licensing would allow them to provide preventive healthcare and treat disease “naturally.” That’s always a selling point and a pretense to engage in the sort of awful quackery they actually specialize in. Since there is no standard of care in naturopathy, patients are at the mercy of whatever diagnoses and treatments the naturopath pulls out of his or her bag of tricks. If you don’t believe me, you should “listen in” on conversations among naturopaths about their patients, as David Gorski was able to do, which, as he said, “revealed just how quacky they are.
All one need do to see how all of this plays out in actual practice is to look at the websites of naturopaths who practice all over the U.S., even in states where they aren’t licensed.
In Massachusetts, we find naturopaths who advertise ozone and light therapy, alternative cancer treatments, biotherapeutic drainage, bogus lab tests, and electro-dermal screening. And in New York there’s “Dr. Doni,” who offers bogus MTHFR genetic testing, designed to scare patients into thinking they have a greater chance of developing particular diseases. This is used as a pretense for selling patients an expensive program of naturopathic treatments.
And here are a few who practice in Colorado. As I catalogued in a previous post:
They’re using provoked urine tests to identify the ubiquitous toxins NDs claim permeate our bodies so that they can treat this imagined toxic overload with chelating agents. . . . But that’s not all. Colorado NDs are testing blood and saliva so they can diagnose and treat “adrenal fatigue,” another imaginary condition . . . with dietary supplements and strict dietary regimens. They are testing for “food toxicity” because “if you have one or more these symptoms, there is a 95% probability you’ll benefit from a food toxicity test.” This is followed by an impressive list of symptoms that makes one wonder what wouldn’t be a symptom of “food toxicity.” There is “genomic testing to determine genetic need for specific nutrients,” another dubious test debunked by Quackwatch. They are testing blood to measure IgG response to a wide selection of foods which, in the alternative reality of alternative medicine, raises the possibility of digestive problems. (Scott Gavura: “These tests lack both a sound scientific rationale and evidence of effectiveness.”)
But wait – that’s not all! More Colorado naturopathic practices were discussed in an earlier post, including bio-identical hormones, craniosacral therapy, reiki, chelation and visceral manipulation.
The Society for Science-Based Medicine, in its report on licensing naturopaths in Maryland, made an extensive list of the nonsensical diagnostic methods and treatments being offered by naturopaths there, complete with references debunking them, including alkaline diets, MELISA testing, autonomic response testing and far-infrared saunas.
Mark Crislip also looked at naturopathic websites of practitioners in the Northwest U.S., and found many of the same practices, as did those who investigated naturopathic websites in Canada, where a licensed naturopath’s recommendation of tincture of echinacea for a toddler suffering from meningitis, who died shortly thereafter, was discussed here on SBM and in the American and Canadian press. In sum, as the authors of Supported by Science: What Canadian Naturopaths Advertise to the Public concluded:
A review of the therapies advertised on the websites of clinics offering naturopathic treatments does not support the proposition that naturopathic medicine is a science and evidence-based practice.
Of course, as in other states where they are not licensed, Michigan naturopaths appear undaunted by the fact that they cannot practice legally. For example, under “Treatments,” Dimpi Patel, ND, says she treats all sorts of problems with menstruation, hormonal “imbalance,” uterine fibroids, polycystic ovary syndrome, peri-menopause, endometriosis , vaginal infection and inflammation, ADD/ADHD, panic and anxiety disorders, depression, OCD and bi-polar I and II disorder. As a matter of fact, only certain licensed health care practitioners (such as MDs) are legally authorized to treat disease.
You’ll find all the usual bread-and butter-naturopathic practices offered in Michigan, such as elimination of toxins via colon hydrotherapy (Cutler Integrative Medicine), “leaky gut” (Michelle Crowder, ND), mistletoe therapy for cancer (Jen Green, ND), chronic candidiasis, which apparently has a new name: “candidiasis syndrome,” (Ellen Kahn, ND), NAET (Healing Paths) and (of course!) cleansing and detoxification (Grand Rapids Natural Health).
I hope this tour of what naturopaths actually do, as opposed to what they claim they do, will dissuade Michigan legislators from voting to license them. Not only that, I hope they’ll investigate and take steps to stop these harmful practices.Legislative Alchemy: Michigan House Bill 4531 gives naturopaths a broad scope of practice Jann Bellamy