Thanks for playing

First, thank you for all the wonderful comments on yesterday’s post. I never really know which posts are going to rake in the comments—my favorites are usually the quietest, and some of my quickies bring ’em in by the dozen. According to my uber-seekrit data, I’ve had two unique visitors to my naturopath post. As erv would say, “UR DOING IT RONG!11!!”

Anyway, I would like to thank my commenters on that post. Even those of you who I think are terribly wrong were at least civil.

I’d love to address all of the issues raised in the comments but I’m far too lazy busy at the moment, but I’d like to focus on a few issues.

First, I still haven’t found an over-arching authority over naturopathic education and practice equivalent to real doctors. Second, much of what I’ve read so far follows an new and interesting path—a large number of very intelligent, very well-educated, very well-intentioned shamans.

Anyway, let’s examine some of the misconceptions raised in the comments.

From a (presumably) green amphibian:

Today, non-specialist (the GPs that do most treatment) do not “determine what the problem is”. You can’t possibly do so with 15 minute consults. In engineering, when you troubleshoot, you have the time to go altering one variable after another, attempting to isolate a fault, given systemic conditions. If you just hack away, hoping that a fix will work — well, you’re just not an engineer — you’re a tech (and not a very good one, at that).

That’s not what case management is. In case management, you try different solutions without ever trying to isolate the problem. You never have the leisure to actually think about it systematically — you try treatments in order of success rates until one “works”. That’s hardly scientific.

I’ve known quite a few old-timey doctors — they’ve all been itching to retire because they don’t want to be involved in today’s quackish, assembly line medicine. Really, get to know some real doctors. Ask them what they do — the guys in their fifties and up will repeat exactly this. It’s not engineering, and it’s not science, it’s following a cookbook. They’re techs.

And for the idiots out there who will scream “But that’s not what I do!”, of course there are exception. But this is what the training regime is for pediatricians, GP and other non-specialists. Some folks are smart enough to disregard their crappy training, and find some way to make it work economically.

There is a great deal of unfounded assertion contained in these few sentences. Medicine isn’t engineering…it’s not even really analogous. We have our own methods and data. I’m not sure what froggie means by “case management”, but in my world, that’s what specialized nurses and social workers do in the hospital—they help patients arrange safe discharge plans.

I don’t know what medical school and residency frog attended, but it seems rather divorced from reality. I spend whatever time I need with a patient. Sometimes I’m rather pressed, but that doesn’t really change things all that much. Some patients need a quick check in with me, others need a lot of my time. Square pegs do not get shoved into round holes. I have all the time to think that I want or need, and sometimes ideas come to me later, after conferring with colleagues, reading, or thinking, at which point I can call a patient up for follow up. There is nothing “cookbook” about it except for the part where I rely on evidence to inform my practice.

OK, now that I’m re-reading these comments, I’m finding froggy even more ignorant and offensive.

A great deal of diabetes treatment is a) recognizing it early b) tracking nutritional habits often and explicitly. An decently trained acupuncturist is actually more likely to do a good job of that than an MD. They see their patients more often, they apply old-fashioned diagnoses such as looking at their patients closely and smelling them closely (which is much more likely to id diabetes very early on than waiting for an acute episode), and talk to their patients regularly about their nutritional habits.

Treatment of many chronic conditions doesn’t require medical school and residency, but basic training in psychology, nutrition, close observation, and a basic physiological knowledge. Even for some acute conditions, a decent acupuncturist is more likely to pick up on melanomas and such earlier than the GP so they can be referred up the chain.

You have to be kidding. An acupuncturist is likely to do a better job than a real doctor? On what planet? And do they have pizza there?

I know quite a bit about diabetes. There is no evidence that frequent sniffing of patients aids in the diagnosis of diabetes. There is evidence that measuring fasting blood glucose and assessing for typical symptoms of diabetes is useful. We screen for diabetes regularly in the real world of medicine.

I’m still curious to learn what naturopaths think they know that the scientific medicine community is missing. Is there a whole literature out there under the radar?

I don’t think so. I think naturopaths are just another kind of snake-oil salesman—they are well-educated, but use unproved techniques, and bizarre ideas to practice medicine. The fact that many of them mean well makes them even more dangerous.