My brother, who is a dentist, needed a patient to have her primary care physician (PCP) coordinate some relevant health issue. She responded that he could consult with her “gynecologist”, who handles her primary care. “Your OB/GYN?” he asked, and she confirmed with a shrug, but added something like, “yeah, she focuses on women’s health issues.”
As you know, not only do obstetrician/gynecologists (OB/GYNs) focus on women’s health issues, but women’s health constitutes 100 percent of what they do. Why then did the patient feel the need to note the focus of a gynecologist? The answer came when my brother looked up the gynecologist and found that she was not an OB/GYN, nor was she a family physician doing OB/GYN as part of her practice, as many family physicians are trained to do at a certain level. It turned out that she is an ND. That’s not a typo, nor is it the ND that stands for North Dakota. The “gynecologist” of his patient is a naturopath who describes herself as specializing in women’s health issues. As for the patient, rather than being some kind of ideolog who rejects science-based health care, apparently she just didn’t realize the difference.
There is a great deal of misinformation floating around in our time, after all, and much of our population is science illiterate. Consequently, there is no shortage of alternative healthcare gurus capitalizing on the situation by selling their books, along with a smorgasbord of health evaluations and treatments and ideologies that the medical profession has been dismissing as witchery since the 18th century, but confusing a naturopath with an OB/GYN is a pretty big misconception. Is the widespread science illiteracy that plagues our society enough to explain it? Probably not, because there is also an issue that we of the pro-science perspective —which includes science based health care— often fail to appreciate, namely that there are reasons why consumers, patients, and prospective health care providers (young people aspiring to heal) build up negative attitudes against the medical profession and the scientific world upon which it is based.
The reasons do not include what naturopaths typically claim in defense of their industry, that MDs, and other health providers, ignore the presence of various health conditions that are treatable with various treatments that are not accepted by the US Food and Drug Administration (FDA) or equivalent regulatory agencies in other countries. In reality, the naturopathy industry is like a magnet for all of the various people with woo woo health beliefs to market those beliefs, and associated “therapies,” to consumers. Consequently, you can find NDs engaged in all sorts of witchery practices, from blood letting to treat high LDL serum cholesterol (bad cholesterol), to homeopathy (use of toxins diluted to ridiculously low concentrations to treat symptoms that higher doses of the same toxins would cause), to administering herbal substances and other unregulated agents of unknown purity and concentration intravenously, to “medical astrology”.
Nor do the reasons include another common claim of naturopaths, that their industry provides society with safe, effective primary health care but is tarnished, only by the presence of numerous untrained, unlicensed people calling themselves naturopaths. While it is true that naturopaths include many well-meaning people —including some who routinely look up the guidelines of science-based medicine and limit their work to things like prescribing proven, science-based treatments, like oral contraceptives, folic acid and iron supplementation, and antibiotics when appropriate, and vaccines— the designation of “licensed ND” is misleading. The naturopathic industry itself handles the education and licensing of NDs, and that education and the content of what aspiring naturopaths must know to pass the licensing exams are the very things at issue. It’s kind of like that old movie, Austin Powers, when the villain points out his credentials, very strongly, that he’s Dr. Evil, that he hadn’t spent eight years in evil medical school to be called Mr. Evil. There may be quite a few people practicing as naturopaths who did not go to naturopathic school, but this doesn’t make licensed naturopathy safe.
Regarding the dominance of woo diagnostics and therapies and the low emphasis on the basic medical sciences in naturopathy training itself, much of the available information comes from a naturopathy apostate whistle blower, Britt Marie Hermes, who has exposed the naturopathy industry through writings and a series of wonderful talks and interviews. One excellent interview of Britt that you should hear is by ZDoggMD, an episode titled “Ditching Naturopathy for Real Science”. In addition to recounting several clinical horrors of naturopathy, Britt explains how, apart from gross anatomy, the basic medical science course work at her ND school —subjects like biochemistry, physiology, and pharmacology— was at the undergraduate college level at best. This is rather shocking to those of us who went to MD school, because just about everything in medicine is built upon those basic sciences, and you keep relearning the basic sciences more deeply. Additionally, it means that nursing and physician assistant students learn these basic sciences more deeply, and apply them more appropriately, than ND students, as they well should.
Even worse, in some US states —and naturopaths are working to increase the number of states and Canadian provinces where this is true— the scope of practice permitted to any naturopath who is “licensed” —has received a naturopathy degree (ND or NMD) and passed naturopathic licensing exams— is quite broad, including things like prescribing medications, giving and ordering injections and intravenous treatments, and performing minor surgery. In Arizona, the scope of practice permitted to naturopaths is so broad that a new ND graduate who has passed his or her licensing exam, can be issued a DEA number, which allows the person to prescribe controlled substances. Along with the fact that the pharmacology taught in ND schools is very scant and corrupted with courses in homeopathy and other pseudoscience, consider that in no US state can an MD be issued a DEA number right out of medical school. To receive a DEA number, and even to be able to prescribe any prescription medications unsupervised, an MD must complete at least one year of post graduate training in addition to passing the licensing exam for MDs. Additionally, MDs from other countries must complete two or three years (depending on the state) of post graduate training in the US to have this privilege, which leads to a ridiculous scenario: An experienced MD from overseas who is fully trained and credentialed in his or her country in a specialty, such as cardiology, surgery, or OB/GYN, cannot prescribe you an antibiotic or oral contraceptives, but a newly graduated naturopath can dispense opioids, infuse you with substances, and suture an injury. So if your idea of a naturopath up to now has been an earthy-crunchy would-be organic food store owner, giving out overpriced multivitamins and placebos, it’s time to change that idea. Naturopaths and the industry that they serve are incredibly dangerous.
Unfortunately, there are very few naturopaths whistleblowing and outreaching to the extent that Britt has done, because NDs often are financially trapped into continuing their naturopathy careers. Meanwhile, they have been indoctrinated with naturopathic ideology. Then, when they begin working in clinics, their positive attitudes about naturopathy dovetail with the negative attitudes that they hear from patients and from teachers about the medical profession.
As we have noted above, there are some legitimate reasons for those negative attitudes. Notably, these reasons include health care providers and institutions seeming to rush patients through appointments. Certainly this has to do a lot with the fact that medicine is very hard and there are numerous tests that doctors need to do behind the scenes for each patient, and very high volumes of patients. In contrast, NDs are reputed for spending large amounts of time with each patient. Naturally, they can afford to do this, because they are charging a lot of money for the time, as patients are typically paying out of pocket, and frankly, also because nobody’s life is in danger if they delay on the next patient. Quite the opposite, for a life-threatening health condition, a patient is much better off, if she leaves from a naturopathic waiting room and obtains science-based health care in the emergency room, urgent care, or any medical clinic. As for minor conditions, people sometimes may feel better after seeing a naturopath, either because of a placebo effect, or because the naturopath did something simple that conforms with normal medical practice that any family doctor or nurse practitioner would do, like providing acetaminophen for a fever, prescribing an appropriate antibiotic for a bacterial infection, or convincing the person to stop smoking and start exercising.
Interestingly, when I looked up ND demographics, I found the proportion of women reported to account from anywhere from 59 percent to 83 percent. That’s a large range, but what is clear is that women are much more likely than men to become naturopaths. This makes sense in context with the fact that, classically, science-based medicine has paid less attention to female patients compared with males. Historically, clinical trials for various treatments have relied disproportionately on male subjects. On top of this, pregnant women have often been excluded from clinical trials, as we have discussed in previous posts related to the COVID-19 vaccines and only in recent years has awareness been growing that there needs to be more emphasis on the health of women. All of this together hints at the possibility that women gravitating to naturopathy and other such health witchery might be the result, not only of the abundance of science illiteracy that is promoted by people who profit from it, but also from a sense that real medicine has been rejecting them to some extent. So women may be a kind of canary in the coal mine, telling us that, in addition to being scientific, which modern health care has been doing increasingly well in recent decades, real medicine should find more ways to make all patients, feel that the are getting the attention that they need.
With this perspective, let’s now take a quick look at what makes OB/GYNs —MDs and DOs who have been through post-graduate training of at least four years specifically in obstetrics and gynecology— uniquely qualified to care for women’s health, both during and outside of pregnancy. Among clinicians overall, OB/GYNs are fairly unique in that they are experts in both medicine and surgery. This means that they really have to retain details of all of the basic medical sciences that they learned in medical school, applying sciences like biochemistry, physiology, endocrinology, and embryology to female and reproductive medicine, and also applying anatomy to surgery in the pelvis and abdomen, plus learning all of the fertility and cancer issues that cross over between the medical and surgical realms of their specialty. Needless to say, an OB/GYN knows how to deliver babies, both vaginally and surgically (cesarean), knows how to make a decision between different vaginal delivery strategies and whether C-section is warranted, and knows how to assess the risk-benefit tradeoff for each patient. We should note that, also practicing within obstetrical and gynecological care are mid-level providers, which include physician assistants (PAs), nurse-midwives and nurse practitioners (types of advanced practice registered nurse), and in some US states associate physicians (or assistant physicians), which are MDs who have not done, or completed, post-graduate training and work under the supervision of a fully licensed physician.
Among the specialists within medicine, OB/GYNs are leading the way in the success of preventive medicine. They are your go-to providers for Pap smear testing, a screen for cellular changes due to human papilloma virus (HPV) infection, and if needed further testing such as colposcopy, biopsies, and various types of excisional biopsies that prevent gynecological cancers, especially cervical cancer, and also for treating such cancers in early stages. Such preventive measures are becoming decreasingly necessary for younger women, only because another preventive measure, HPV vaccination has been preventing the problem at an even earlier stage. In terms of care during pregnancy, in addition to checking the embryo with ultrasonography and blood tests and checking your own health, your obstetrician is your go-to person for routine nutritional measures, such as folic acid supplementation —which is so vital for preventing neural tube defects — and iron supplementation if your blood tests show that you need it.
Modern medicine depends on science and constantly improves itself as we learn more. Set against this standard, naturopathy presents itself as —for lack of a better term— witchcraft. Be knowledgeable about why many people in our society are drawn to it, both as patients and as providers, and also that its legality is expanding to a growing number of US states and Canadian provinces, which represents a public health danger, so don’t be taken in by it. Better yet, when possible, communicate with your state legislators and help to educate them about such quackery, so that we can get the trend of its legalization and acceptance by society reversed.