Colorado naturopaths' talking points a perfect example of why they shouldn't get practice expansion

Colorado naturopaths' talking points a perfect example of why they shouldn't get practice expansion

On Monday, April 17, competing versions of the future of naturopathy in Colorado will duke it out in the state's Senate chambers. In one version of a bill, naturopaths are simply allowed to continue to practice in Colorado. In the other, they will be able to pump patients full of ineffective and potentially dangerous substances via IV. The health and safety of naturopathic patients hangs in the balance.

Naturopaths are worried that the version vastly expanding their scope of practice won't pass in the Senate, prompting the Colorado Association of Naturopathic Doctors (CAND) to send out an SOS asking people to contact their legislators with this canned testimony:

"Naturopathic doctors are well trained on the use of hormone therapy and its dangers. I would like greater choice in my health care provider and the option of using natural hormone therapy if I would ever need it. Intravenous, nutritional therapy has many health benefits, including helping those with a compromised digestive system and those with chronic and acute infections. A recent article showed that IV Vitamin C performed better than IV antibiotics in treating sepsis, a life threatening illness, and another showed its potential benefits in treating cancer alongside chemotherapy. NDs teach the use of IV Nutritional therapy and are well trained on its efficacy and risks. Since few MDs and DOs offer this therapy in Colorado, it would be a significant public health benefit for NDs to be able to provide it."

It would be hard to compose a better indictment of expanded naturopathic practice than the CAND's own effort here. We'll return to their outlandish claims in a moment, but first, a bit of history

In February, the Senate passed Senate Bill 106, which extended the sunset date for Colorado's 2013 naturopathic registration law until 2020, made naturopaths mandatory reporters of abuse, required reporting of malpractice judgments, required the use of "R.N.D." (registered naturopathic doctor) after their names to avoid public confusion about their regulatory status, and clarified their formulary. Senate Bill 106 was pretty much in line with a report from the state's Department of Regulatory Affairs (DORA), which was tasked with making recommendations for amendments to the naturopathic registration law, an undertaking mandated by Colorado law.

In drafting its report, DORA ignored the concerns of experts who testified against the phony assurances of patient safety bestowed by naturopathic registration, which gives an undeserved imprimatur of legitimacy to quack practices like IV hydrogen peroxide, ultraviolet blood irradiation and chelation treatments. Yet, even the naturopath-friendly folks at DORA didn't recommend the sort of practice expansion the House bestowed on Colorado naturopaths. 

After passing in the Senate, SB 106 moved to the House, where naturopaths successfully lobbied to radically amend the bill. It morphed from the drafters' original intent -- to implement DORA's recommendations -- into a giant practice expansion bill. The bastardized bill would allow naturopaths to prescribe hormones (if they collaborate on their use with a physician), and IV vitamins, minerals, chelating agents and amino acids. The House version stripped the bill of the requirement that naturopaths use "R.N.D." and bumped the next sunset review to 2022.

The collaboration agreements are a sham. It is no more than a piece of paper filed with DORA. The naturopath isn't required to consult or alter treatment plans according the advice of the physician; the physician has no authority over the naturopath and can suffer no repercussions when the naturopath screws up. There were 16 of these agreements filed with DORA at the time the Sunset Review was published. (These are required to treat children under the age of two.) Three naturopaths have an agreement with the same physician, who is not even in clinical practice, but rather "research."

The Senate, to its credit, refused to go along with this practice expansion. The bill went to the Conference Committee to try to iron out the differences between the two legislative chambers. They did not, leaving a majority and minority position for the Senate to vote on: The majority position basically being the House version of SB 106 and the minority version more closely following the bill as passed in the Senate. As a "compromise," the House added a whopping seven hours of required training in IV nutrients. (By way of comparison, California requires 25 hours of instruction for IV administration certification, and even that's inadequate.) The vote takes place on Monday.

With that background in mind, let's break down the CAND's plea and see how it aptly demonstrates why naturopaths shouldn't be allowed to prescribe hormones (even with physician oversight) or shoot patients up with IV vitamins, minerals and other concoctions.

Naturopaths love hormones. DORA reports that being able to prescribe hormones was "important" or "very important" to 75% of Colorado naturopaths surveyed and that hormones outranked antibacterial, antifungal and antiviral meds in importance to them. Doesn't that seem odd? Can you imagine a family practice MD or DO, or a nurse practitioner, saying that hormones were more important than medicines fighting bacterial, fungal and viral infections?

And note the reference to "natural" hormones. Naturopaths promote so-called "bioidentical" hormones as "natural," but they are no more effective or safer than any other prescribed hormone. And they are compounded, not manufactured in controlled environment, introducing, as the FDA has warned, the possibility of contamination and inconsistent formulation. That's a risk the sham "collaboration" agreements don't even address. 

I have to assume that the CAND would cite the best evidence it's got to support giving naturopaths the right to pump patients full of vitamins, minerals and such, but their best isn't good enough. They are correct that there were several recent articles purportedly showing that IV Vitamin C performed better than IV antibiotics in treating sepsis. Unfortunately, these articles vastly overhyped the evidence and were rounded criticized for doing so. And it's not just vitamin C that was in the IV given patients: It also included corticosteroids, a prescription drug that naturopaths could not legally use. Most of the medical community remains appropriately skeptical and believes well-conducted clinical trials are necessary before this becomes standard treatment for sepsis. (Not that a naturopath should ever be involved in treating sepsis in the first place.)

The "potential" for Vitamin C in treating cancer is unproven as well, as is the routine use of vitamin infusions. All in all, what the CAND's touting of Vitamin C and other IV vitamin and mineral concoctions shows is that naturopaths don't know how to properly evaluate the evidence. As Steve Novella, MD, said in his SBM post about a California naturopathic patient's death following a curcumin IV infusion,

"This is clearly not just an outlier, the failure of an individual, or an unavoidable fluke. This is a failure of the naturopathic profession. This episode exposes what is clear from any review of naturopathic practice – they base their treatments on a pathetically low standard of evidence. They do not make meaningful risk vs benefit analyses."

That's why, as the CAND points out, "few MDs and DOs offer this therapy in Colorado." They don't offer the kind of IV infusions and "natural" hormones naturopaths routinely prescribe because there isn't sufficient evidence of safety and efficacy to offer them, so they don't meet a physician's standard of care. Naturopaths don't have a standard of care. That's why a naturopathic patient in California was being given a curcumin IV for eczema: There's no good evidence that it would be beneficial for her condition, but naturopaths use curcumin IVs for the same reason they use IV vitamins and minerals, "natural" hormones and chelating agents. It's based on tradition, lore, "naturalness," or what-have-you. Unfortunately, this incompetency cost the young woman in California her life. Colorado legislators should prevent the possibility of unnecessary harms from naturopathic pseudoscience by refusing to pass the House's version of SB 106.

Resources for opposing naturopathic practice expansion in Colorado:

Senate Bill 106 (We'll be following the bill on SFSBM's Legislative Updates.)

Colorado legislators contact information

2017 Fact Sheet on Naturopathic Medicine (from Naturopathic Diaries)

Colorado May Green-Light Naturopathic Doctors, Against Warning (from Forbes)

Points of Interest 04/16/2017
Points of Interest 04/15/2017