Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (6)

Is It Safe For Naturopaths To Prescribe Drugs?

I am a terrible Oregon chauvinist.  I think there is no better place to live on the planet. Period.  Great natural beauty, not a lot of people, best beer ever and no pro football team. Oregon is both casual and tolerant.  It is safe to say that dressing up in the Pacific NW means tucking your t shirt into your jeans.  And the citizens of the NW, especially in the Portland metro area, are tolerant of  a diverse number of alternative life styles. What more could you want?

No good deed goes unpunished. The downside of toleration is the proliferation of alternative medicine.  Portland has  a school of chiropractic, a college of oriental medicine and  the country’s oldest school of naturopathy, established in 1956.  It is a year older than me. There are about 850 ND’s in Oregon.  To judge from the number of alternative practitioner offices around my hospital,  most of the graduates stay in Portland.

There are five health care systems in Portland.   Three of the five have hired naturopaths as part of their complementary medicine programs.   My system, as of yet, does not have a scam practitioner on staff, a fact of which I am most proud.  Yet,  I suppose it will come some day. However, if you wonder if a hospital practices evidence and science based medicine, see if they have a naturopath, a chiropractor or an acupuncturist on staff.  If they do, they may be interested in issues other than providing quality health care.

Oregon has had a Board of Naturopathic physicians since 1929 to oversee naturopathic practice.  There has been a long tradition of legislative oversight of naturopathy in Oregon, but they have been able, until recently, to only prescribe medications that are naturally derived.  None of that synthetic nonsense for naturopaths. Natural products only.  Until this month.

In Oregon, naturopaths are no longer limited to natural, herbal and homeopathic concoctions, they can also prescribe substances that actually work.  Recently House Bill 327  was passed by the Oregon legislature to expand the prescriptive privileges of naturopaths.  Drugs can now be added to the naturopathic  formulary just by asking.  The bill was passed by the Senate 22-7 and the House unanimously.  Bummer. If you live in Oregon and want to pester your representative on their profound stupidity, a list is at  http://gov.oregonlive.com/bill/SB327/. Send them a link to this post.

As a “shill for big pharma and a tool of the medical-industrial complex,” I suggest this may not be such a  good idea.  Naturopaths do not have the training, experience  or understanding of medicine to safely prescribe medications. Their understanding of disease and the various therapies taught at naturopathic schools are antithetical to what is required to safely and knowledgeably  prescribe modern medications.

To give prescription medications correctly and safely, one needs to understand anatomy, physiology, pharmacology and the pathophysiology of diseases.  Real medical providers (MD’s, DO’s, NP’s and PA’s)  have to have not only years of education in school, but a residency or other training to be able to appropriately use these medications.

What is a naturopath and what is their education?

First the Philosophy of Naturopathy.  The key components of naturopathy, from the Oregon Board,  sound reasonable in general, but are not so reasonable in their specific application.  Emphasis is added by me of key points to keep in mind as we look to see if granting prescriptive privileges to naturopaths is a good thing.

“The Healing Power of Nature.Vis medicatrix naturae   The body has the inherent ability to establish, maintain, and restore health. The healing process is ordered and intelligent; nature heals through the response of the life force. The physician’s role is to facilitate and augment this process, to act to identify and remove obstacles to health and recovery, and to support the creation of a healthy internal and external environment.”

In naturopathy, you let the body heal itself.  You do not give medications.  There is, by the way, no evidence of a life force.  Magical thinking is major part of the naturopathic philosophy. How prescriptions will fit into this magic is uncertain.

“Identify and Treat the Cause. tolle causam   Illness does not occur without cause.  Underlying causes of disease must be discovered and removed or treated before a person can recover completely from illness. Symptoms are expressions of the body’s attempt to heal, but are not the cause of disease. Symptoms, therefore, should not be suppressed by treatment. Causes may occur on many levels including physical, mental, emotional, and spiritual. The Physician must evaluate fundamental underlying causes on all levels, directing treatment at root causes rather than at symptomatic expression.”

“First, Do No Harm. Primum no nocere    Illness is a purposeful process of the organism.  The process of healing includes the generation of symptoms, which are, in fact, an expression of the life force attempting to heal itself. Therapeutic actions should be complimentary to and synergistic with this healing process.  The Physician’s actions can support or antagonize the actions of the vis medicatrix naturae. Therefore, methods designed to suppress symptoms without removing underlying causes are considered harmful and are avoided or minimized.

Nonsteroidal anti-inflammatories and narcotics are on the list of prescription medications, and are nothing if not symptom suppressors.  Prescription medication seems antithetical to the basic premises of naturopathic theory. Naturopaths always complain that prescriptions medications don’t treat disease, it masks them.  Now they get to join the dark side.

“Treat the Whole Person. The Multifactorial Nature of Health and Disease   Health and disease are conditions of the whole organism, a whole involving a complex interaction of physical, spiritual, mental, emotional, genetic, environmental, social, and other factors. The Physician must treat the whole person by considering all of these factors. The harmonious functioning of all aspects of the individual is essential to recovery from and prevention of disease, and requires a personalized and comprehensive approach to diagnosis and treatment.”

That should lead to creative uses of prescription medications.  The power of modern medicine comes from understanding that many diseases are best treated the same way for everyone.  In the hospital we have guidelines for the prevention and treatment of many diseases.  Multiple studies demonstrate that when patients are treated the same, morbidity and mortality declines.  We have driven hospital acquired infections to almost zero in my hospitals by treating every patient identically based on evidence and science.

And what modalities do Naturopaths use? Few that are based on science and clinical trials.

“Clinical Nutrition.  That food is the best medicine is a cornerstone of naturopathic practice.  Many medical conditions can be treated more effectively with foods and nutritional supplements than they can by other means, with fewer complications and side effects. Naturopathic Physicians use dietetics, natural hygiene, fasting, and nutritional supplementation in practice.”

Botanical Medicine.  Many plant substances are powerful medicines. Where single chemically derived drugs may only address a single problem, botanical medicines are able to address a variety of problems simultaneously. Their organic nature makes botanicals compatible with the body’s own chemistry; hence, they can be gently effective with few toxic side effects.

Homeopathic Medicine.  Homeopathic medicine is based on the principle of “like cures like.”  It works on a subtle yet powerful electromagnetic level, gently acting to strengthen the body’s healing and immune response.”

I will pause here to point out that if a provider believes that homeopathy is a reasonable therapeutic intervention, they cannot be trusted to understand modern pharmacology.   It is said that the mark of an educated person is the ability to hold two contradictory ideas in the mind at the same time.  That must be true of naturopaths if they can simultaneously think that modern pharmaceuticals and homeopathic nostrums can be used at the same time.

“Physical Medicine.  Naturopathic Medicine has its own methods of therapeutic manipulation of muscles, bones, and spine. ND’s also use ultrasound, diathermy, exercise, massage, water, heat and cold, air, and gentle electrical pulses.”

“Oriental Medicine.  Oriental medicine is a complimentary healing philosophy to naturopathic medicine. Meridian theory offers an important understanding of the unity of the body and mind, and adds to the Western understanding of physiology. Acupuncture theories, without the insertion of acupuncture needles,  provide methods of treatment utilized in naturopathic medicine that can unify and harmonize the imbalances present in disease conditions, which, if untreated, can result in illness.”

Look at the list: nutritional supplements, homeopathy, acupuncture, hydrotherapy and electrical stimulation.  There is no nonsensical therapy that is not in the naturopathic armamentarium. That is part of the problem with describing the practice of naturopathy: any and all medical magic is in their pervue. And all these magical inanities are supported by the board that oversees naturopathic physicians and licenses them. This will be the governing body to decide which medications naturopaths can prescribe. The untrained request from the ignorant the ability to use prescription medications neither understands. Great plan.

If you google naturopathy and hypertension, the first hit I get is at altmd.com.  Take a moment to review http://www.altmd.com/Articles/Naturopathic-Medicine-for-Hypertension.  Healing rocks. Color therapy. Alternating hot and cold foot baths.  All naturopathic treatments of hypertension.

Yet the state of Oregon feels people who treat hypertension with magic rocks will be able to safely give medications with real effects and side effects  and should have access to real medications. It is the equivalent of having people who think planes are kept aloft with fairies wings becoming pilots or having  bridges designed by people who think the central span will be supported by the positive thinking of those traveling across the bridge.

It is scary to let people trained in magic and premodern concepts of disease to give dangerous drugs.

The full list of medications to be allowed is at the end of the post. You will be happy to know, however, that “Board approved certification is required before therapeutic IV chelation is allowed.”  What a relief. I am certainly glad the State board is making sure that useless and potentially fatal chelation therapy requires certification. My tax dollars inaction.

Per the Board, “Naturopathic Physicians (N.D.) are primary care practitioners trained as specialist in natural medicine (1).”

Primary care practitioners?  OK.  In the world of real medicine, we have two kinds of primary care physicians: internists and family physicians.  They have four years of medical school and then a three year residency, taking care of patients under the guidance of senior physicians,  to learn the basics of their job before going into practice.  Most naturopaths do not have to have a residency (5) going straight to patient care from school.

The training requirements in pharmacy, per the naturopathic board, is minimal:  “Naturopathic physicians are required to take 72 hours of pharmaceutical training as a part of  their doctoral degree. Additionally, they must also have 1,500 hours of clinical training. Naturopathic physicians are required to take 25 hours of continuing education course work annually, five of which must be in pharmacology.”

Nine days of pharmacy training in school in school. 1500 hours is 35 forty hour weeks.  A little over half a year of clinical experience. That is the background of naturopaths who will give medications.  For comparison,  in med school we spent 4 hours a day for the three months of the second year in pharmacology and  I had five years of clinical experience just for internal medicine.

At our local naturopathic school they get 72 hours of pharmacology education, and twice (144 hours) as much training in homeopathy (6).  The have the opportunity to do electives to broaden their knowledge: 144 hours in homeopathy,  36 hours in qi gong, 26 hours in Aruyveda, 24 hours in energy work and 12 hours in colonics. But no electives in pharmacology. A good foundation upon which to prescribe medications.

It is also odd finding vaccines on the list, given the long standing opposition of  many naturopaths to vaccines.

The local paper, the Oregonian, did not see giving prescriptive to shamans  with minimal education and experience as a quality issue.  They, as well as the sponsoring Senator, saw it as a “turf battle” between MD’s and ND’s.  I am not surprised as the Oregonian is not noted for its critical think skills to judge from the articles in the weekly medical edition of the “Way We Live” section (4).

It is a quality issue.  If you have people giving drugs they don’t understand for diseases they don’t understand, then problems will occur.  Put a loaded gun in a room of deaf and blind people and someone going to get shot.

If I were Pfizer I would be turning my sales force loose on the 800 plus ND’s in Oregon:  they have no background to understand the truth of what they are told, they have no critical thinking skills, they are used to accepting authority over evidence, they have no issues with being subsidized by industry, and crave respectability.  Perfect fodder for the drug rep.  They don’t have a chance. And neither do their patients.

I like living in a tolerant state.
But there are down sides.

======

1) http://www.oregon.gov/OBNE/Aboutnaturopathy.shtml

2)  http://www.ncnm.edu/naturopathic-medicine-residency-program.php

3) I cannot help but notice that while in our residency program there is zero interaction with any pharmaceutical company, one ND residency is “is receiving the generous support from:, Bezwecken, Biogenesis, Emerita, Integrative Therapeutics Inc., National College of Natural Medicine, Natural Health International, Vital Nutrients, Vitanica, Women’s International Pharmacy”

4) As I write this on 6/17, the Oregonian published a puff piece on Guided Imagry and Cancer therapy, part of which is here (http://www.oregonlive.com/health/index.ssf/2009/06/a_brief_guide_to_guided_imager.html)  and here: http://www.oregonlive.com/health/index.ssf/2009/06/greenlick_combines_standard_an.html

If they print this kind of nonsense, how can I trust their news reporting?  My wife insists on the paper, otherwise I would have given up my subscription years ago.

5)  There are a few naturopathic residencies where they can hone their skills in using rocks. It would appear that most naturopathic residency programs are supported by pharma.  But they have no conflicts of interest. Oh no. I though MD’s were the tainted ones.

http://www.ncnm.edu/naturopathic-medicine-residency-program/dr.-hudson.php.

http://www.naturopathicresidency.org/support.html

6) http://www.ncnm.edu/academics-at-ncnm/Programs_08-09.htm

Naturopathic Formulary

(1) Abacavir (2) Acarbose (3) Acetic Acid (4) Acetylcysteine (5) Acitretin (6) Acyclovir (7) Adapalene (8) Adenosine Monophosphate (9) Albuterol Sulfate (10) Alendronate (11) Allopurinol (12) Alprostadil (13) Amantadine (14) Amino Acids (15) Amino Aspirins (16) Aminoglycosides (17) Aminolevulinic Acid (18) Aminophylline (19) Aminosalicylic Acid (20) Ammonium Chloride (21) Ammonium lactate lotion 12% (22) Amoxicillin (23) Amoxicillin & Clavulanate (24) Amphotericin B (25) Ampicillin (26) Ampicillin & Sulbactam (27) Anastrozole (28) Anthralin (29) Atorvastatin (30) Atropine (31) Atropine Sulfate (32) Auranofin (33) Azelaic Acid (34) Azithromycin (35) Bacampicillin (36) Bacitracin (37) Baclofen (38) Becaplermin (39) Belladonna (40) Benazepril (41) Benzodiazepines (42) Benzoic Acid (43) Benzonatate (44) Betaine (45) Betamethasone (46) Bethanechol Chloride (47) Bichloracetic Acid* (48) Bimatoprost Solution 0.03% (49) Biologicals (50) Bisphosphonates (51) Bromocriptine (52) Budesonide (53) Buprenorphine (54) Butorphanol (55) Cabergoline (56) Calcipotriene (57) Calcitonin (58) Calcitriol (59) Carbamide Peroxide (60) Carbidopa (61) Carbol-Fuchsin (62) Captopril (63) Cefaclor (64) Cefdinir (65) Cefibuten (66) Cefadroxil (67) Cefditoren (68) Cefixime (69) Cefonicid Sodium (70) Cefpodoxime Proxetil (71) Cefprozil (72) Ceftibuten (73) Cefuroxime (74) Celecoxib (75) Cellulose Sodium Phosphate (76) Cenestin (77) Cephalexin (78) Cephradine (79) Chirocaine* (80) Chloramphenicol (81) Chloroquine (82) Citrate Salts  (83) Clarithromycin (84) Clindamycin (85) Clioquinol (86) Clostridium botulinum toxin (ab) (87) Cloxacillin (88) Codeine (89) Colchicine (90) Colistimethate (91) Collagenase (92) Condylox (93) Cortisone (94) Coumadin (95) Cromolyn Sodium (96) Cyanocobalamin (97) Cycloserine (98) Cytisine (99) Danazol (100) Deferoxamine / Desferroxamine (Board approved certification required before therapeutic IV chelation is allowed) (101) Demeclocycline Hydrochloride (102) Desmopressin (103) Desoxyribonuclease (104) Dexamethasone (105) Dextran (106) Dextromethorphan (107) Dextrose (108) Dextrothyroxine (109) Dicloxacillin (110) Dihydroergotamine Migranal (111) Didanosine (112) Dimethyl Sulfone (DMSO) (113) Digitalis (114) Digitoxin (115) Digoxin (116) Dinoprostone (117) Diphenhydramine 118) Diphylline (119) Dirithromycin (120) DMPS (Board approved certification required before therapeutic IV chelation is allowed) (121) DMSA (122) Doxercalciferol (123) Doxycycline (124) Dronabinol (125) Dyclonine (126) EDTA (Board approved certification required before therapeutic IV chelation is allowed) (127) Electrolyte Solutions (128) Emtricitabine (129) Enalapril (130) Ephedrine (131) Epinephrine* (132) Epinephrine (auto-inject) (133) Ergoloid Mesylates (134) Ergonovine Maleate (135) Ergotamine (136) Erythromycins (137) Erythropoietin (138) Estradiol (139) Estriol (140) Estrogen-Progestin Combinations (141) Estrogens, Conjugated (142) Estrogen, Esterified (143) Estrone (144) Estropipate (145) Eszopiclone (146) Ethyl Chloride (147) Etidronate (148) Exenatide (149) Ezetimibe (150 Famciclovir (151) Fentanyl (152) Fibrinolysin (153) Flavoxate (154) Fluconazole (155) Fludrocortisone Acetate (156) Flunisolide (157) Fluorides (158) Fluoroquinolones (159) Fluoroquinolines (160) Fluorouracil (161) Fluticasone propionate (162) Fluvastatin (163)  Fosinopril (164) Gaba Analogs (165) Gabapentin (166) Galantamine H. Br. (167) Gamma-Hydroxy Butyrate (168) Ganciclovir (169) Gentamicin (170) Gentian Violet (171) Glycerin/Glycerol (172 Griseofulvin (173) Guaifenesin (174) Heparin – subcutaneous, sublingual
and heparin locks (175) Hexachlorophene (176) Homatropine Hydrobromide* (177) Human Growth Hormone  (178) Hyaluronic Acid (179) Hyaluronidase (180) Hydrocodone (181) Hydrocortisone (182) Hydrogen Peroxide (183) Hydromorphone (184) Hydroquinone (185) Hydroxychloroquine (186) Hydroxypolyethoxydodecane* (187) Hyoscyamine (188) Iloprost Inhalation Solution (189) Imiquimod Cream (5%) (190) Immune Globulins* (191) Insulin (192) Interferon Alpha b w/Ribaviron (193) Iodine (194) Iodoquinol (195) Iron Preparations (196) Isosorbide Dinitrate (197) Isotretinoin (198) Itraconazole (199) Kanamycin Sulfate (200) Ketoconazole (201) Lactulose (202) Lamivudine (203) Letrozole (204) Leucovorin Calcium (205) Levalbuteral (206) Levocarnitine (207) Levodopa (208) Levonorgestrel (209) Levorphanol (210) Levothyroxine (211) Lincomycin (212) Lindane (213) Liothyronine (214) Liotrix (215) Lisinopril (216) Lisuride (217) Lithium (218) Lovastatin (219) Mebendazole (220) Meclizine (221) Medroxyprogesterone (222) Medrysone (223) Mefloquine (224) Megestrol Acetate (225) Mercury, Ammoniated (226) Memantine (227) Mesalamine (228) Metformin (229) Methadone (230) Methimazole (231) Methoxsalen (232) Methscopolamine (233) Methylergonovine (234) Methylprednisolone (235) Methylsulfonylmethane (MSM) (236) Methyltestosterone (237) Methysergide (238) Metronidazole (239) Miglitol (240) Minerals (Oral & Injectable) (241) Minocycline (242) Misoprostol (243) Moexipril (244) Monobenzone (245) Morphine (246) Mupirocin (247) Nafarelin acetate (248) Naloxone (249) Naltrexone;  (250)Natamycin (251) Nateglinide (252) Nicotine (253) Nitroglycerin (254) Novobiocin (255) Nystatin (256) Olsalazine (257) Omeprazole (258) Opium (259) Over the Counter (OTC)  (260) Oxacillin (261) Oxamniquine (262) Oxaprozin (263) Oxtriphylline (264) Oxycodone (265) Oxygen (266) Oxymorphone (267) Oxytetracycline (268) Oxytocin* (269) Pancrelipase (270) Papain (271) Papavarine (272) Paramethasone (273) Paregoric (274) Penciclovir (275) Penicillamine (Board approved certification required before therapeutic IV chelation is allowed) (276) Penicillin (277) Pentosan  (278) Pentoxifylline (279) Pergolide (280) Perindopril (281) Permethrin (282) Phenazopyridine (283) Phenylalkylamine (284) Phenylephrine* (285) Physostigmine (286) Pilocarpine (287) Pimecrolimus Cream 1% (288) Piperazine Citrate (289) Podophyllum Resin (290) Polymyxin B Sulfate (291) Polysaccharide-Iron Complex (292) Potassium Iodide (293) Potassium Supplements (294) Pramoxine (295) Pravastatin (296) Praziquantel (297) Prednisolone (298) Prednisone (299) Pregabalin (300) Progesterone (301) Progestins (302) Propionic Acids (303) Propylthiouracil (304) Prostaglandins (305) Proton Pump inhibitor (306) Pseudoephedrine (307) Pyrazinamide (308) Pyrethrins (309) Quinapril (310) Quinidine (311) Quinilones (312) Quinine Sulfate (313) Quinines (314) Quinolines (315) Ramopril (316) Rauwolfia Alkaloids (317) Rho(D) Immune globulins  (318) Rifabutin (319) Rifampin (320) Rimantidine (321) Risendronate (322) Ranolazine (323) Salicylamide (324) Salicylate Salts (325) Salicylic Acid (326) Salsalate (327) Scopolamine (328) Selegiline (329) Selenium Sulfide (330) Sildenafil Citrate (331) Silver Nitrate (332) Simvastatin (333) Sitagliptin (334) Sodium Polystyrene Sulfonate (335) Sodium Tetradecyl Sulfate  (336) Sodium Thiosulfate (337) Spironolactone (338) Stavudine (339) Spectinomycin (340) Sucralfate (341) Sulfasalazine (342) Sulfonamide/Trimethoprim/Sulfones (343) Tacrolimus (344) Tazarotene topical gel (345) Telithromycin (346) Tenofovir (347) Testosterone (348) Tetracycline (349) Theophylline (350) Thiabendazole (351) Thyroid (352) Thyroxine (353) Tiagabine (354) Tibolone (355) Tiludronate (356) Tinidazole (357) Tobramycin (358) Topical steroids (359) Tramadol (360) Trandolapril (361) Trazodone (362) Tretinoin (363) Triamcinolone (364) Triamterene (365) Trichloracetic Acid* (366) Trimetazidine (367) Trioxsalen (368) Triptans (369) Troleandomycin (370) Undecylenic Acid (371) Urea (372) Urised (373) Ursodiol (374) Valacyclovir (375) Valproic Acid (376) Vancomycin (377) Varenicline (378) Verapamil (379) Verdenafil HCL (380) Vidarabine (381) Vitamins (Oral & Injectable) (382) Yohimbine (383) Zalcitabine (384) Zidovudine (385) Zolpidem (386) Local Anesthetics: (a) Benzocaine* (b) Bupivacaine* (c) Chloroprocaine* (d) Dyclonine* (e) Etidocaine* (f) Lidocaine* (g) Lidocaine (non-injectable dosage form) (h) Mepivocaine* (i) Prilocaine* (j) Procaine* (k) Tetracaine*.
(387) Vaccines: (a) BCG* (b) Cholera* (c) Diptheria* (d) DPT* (e) Haemophilus b Conjugate* (f) Hepatitis A Virus* (g) Hepatitis B* (h) Influenza Virus* (i) Japanese Encephalitis Virus* (j) Measles Virus* (k) Mumps Virus* (l) Pertussis* (m) Plague* (n) Pneumococcal* (o) Poliovirus Inactivated* (p) Poliovirus-Live Oral* (q) Rabies* (r) Rubella* (s) Smallpox* (t) Tetanus IG* (u) Tetanus Toxoid* (v) Typhoid* (w) Varicella* (x) Yellow Fever* (388) SkinTests:
(a) Diptheria* (b) Mumps* (c) Tuberculin*.


*This blog post was originally published at Science-Based Medicine*


You may also like these posts

Read comments »


6 Responses to “Is It Safe For Naturopaths To Prescribe Drugs?”

  1. Laura Simmons says:

    I love Oregon as well. The only thing I hear is that there is a great deal of depression due to all of the rain.

    But when it concerns natural health/alternative health or complementary medicine (whichever name you give it) you have to understand people's reason for this. Too many people either misdiagnosed sometimes due to food intolerance and allergies and other that were never diagnosed and fortunately recovered not to mention drug dependencies on all of the anti-depressants and the harsh side effects of many pharmacueticals.

    I can tell you that I have had personal experience with several natural remedies are they solved problems that doctors could not. Modern medicine has too many limitations and side effects.

  2. Laura Simmons says:

    I love Oregon as well. The only thing I hear is that there is a great deal of depression due to all of the rain.

    But when it concerns natural health/alternative health or complementary medicine (whichever name you give it) you have to understand people's reason for this. Too many people either misdiagnosed sometimes due to food intolerance and allergies and other that were never diagnosed and fortunately recovered not to mention drug dependencies on all of the anti-depressants and the harsh side effects of many pharmacueticals.

    I can tell you that I have had personal experience with several natural remedies are they solved problems that doctors could not. Modern medicine has too many limitations and side effects.

  3. Hamlet says:

    Wow. Such invective and arrogance. I guess you have the entire system figured out. Maybe you should be put in charge of the entire healthcare system as who could know more than you?
    Dr. Crislip, you are a bit like Horatio, who cannot conceive of things beyond your limited philosophy. Fortunately for you, as you have mentioned, Oregonians are likely to forgive your short-sightedness and the limitations of your experience, but perhaps may be a bit less forgiving for your intolerant distortion of the facts and outright lies. You must embarrass your employer, your family, and most unlikely and most tellingly yourself. Your tone is that of Dr. Stephen Barret, MD without the dismissal by courts of law http://www.canlyme.com/quackwatch.html who was discredited by essentially being recognized as a polemicist.
    Really, I think Oregon legislators are far more intelligent than you, clearer thinkers, less biased, and more interested in the greater good.

    You obviously have an axe to grind and do not want to be burdened by the facts.

    The facts are that the medical program at OHSU does not include pharmacology.
    That MDs and DOs are not required by state law to have any continuing medical education.
    That many MDs and DOs do give much advice that is not scientific, not validated, and shown to be outright dangerous.
    That NDs are not usually responsible for patient deaths and are much safer practitioners and the facts about “scientific” medical errors are here http://www8.nationalacademies.org/onpinews/news...

  4. Hamlet says:

    Wow. Such invective and arrogance. I guess you have the entire system figured out. Maybe you should be put in charge of the entire healthcare system as who could know more than you?
    Dr. Crislip, you are a bit like Horatio, who cannot conceive of things beyond your limited philosophy. Fortunately for you, as you have mentioned, Oregonians are likely to forgive your short-sightedness and the limitations of your experience, but perhaps may be a bit less forgiving for your intolerant distortion of the facts and outright lies. You must embarrass your employer, your family, and most unlikely and most tellingly yourself. Your tone is that of Dr. Stephen Barret, MD without the dismissal by courts of law http://www.canlyme.com/quackwatch.html who was discredited by essentially being recognized as a polemicist.
    Really, I think Oregon legislators are far more intelligent than you, clearer thinkers, less biased, and more interested in the greater good.

    You obviously have an axe to grind and do not want to be burdened by the facts.

    The facts are that the medical program at OHSU does not include pharmacology.
    That MDs and DOs are not required by state law to have any continuing medical education.
    That many MDs and DOs do give much advice that is not scientific, not validated, and shown to be outright dangerous.
    That NDs are not usually responsible for patient deaths and are much safer practitioners and the facts about “scientific” medical errors are here http://www8.nationalacademies.org/onpinews/news...

  5. very sick me says:

    Scathing but necessary. Scores of alternative treatments are great for simple issues, especially those of psychological etiology, or for people looking for some relief, even if it is just observing soothing colors or feeling the warmth of salt rocks, when Western medicine doesn't have many options.
    But there's a reason why naturopaths and medical doctors recieve distinct training and distinct credentials, a reason which should extend to the scope of treatment. I guess it's an impressive political accomplishment, this Oregon allowance, to say the least.

    Now to go see a real doc for my skin rash…and maybe have a nice cup of chai, without expecting it to cure me quick.

  6. very sick me says:

    Scathing but necessary. Scores of alternative treatments are great for simple issues, especially those of psychological etiology, or for people looking for some relief, even if it is just observing soothing colors or feeling the warmth of salt rocks, when Western medicine doesn't have many options.
    But there's a reason why naturopaths and medical doctors recieve distinct training and distinct credentials, a reason which should extend to the scope of treatment. I guess it's an impressive political accomplishment, this Oregon allowance, to say the least.

    Now to go see a real doc for my skin rash…and maybe have a nice cup of chai, without expecting it to cure me quick.

Return to article »

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »