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AMA Declares War on Naturopathic Medicine, Patient Safety and Freedom of Choice in Health Care

By Alex Vasquez, ND, DC, Editor, Naturopathy Digest
AVasquez@NaturopathyDigest.com

Behind the usual façade and overused disguise of "patient safety," "science" and "high standards," the American Medical Association (AMA) and several other allopathic (MD) medical groups are again seeking to limit the scope of practice and state licensure for other duly trained healthcare professionals.1-3

Such actions were deemed illegal less than twenty years ago, when the AMA and several other medical groups were found guilty in federal court for violating the nation's antitrust laws by seeking to create a healthcare monopoly; details of this case were published by court order in the January 1, 1988 issue of the Journal of the American Medical Association (JAMA).4

Illegal actions by the AMA and its co-conspirators included but were not limited to 1) systematic defamation of naturopathic, chiropractic and osteopathic physicians; 2) publishing and distribution of propaganda specifically intended to ruin other healthcare professionals' reputations; 3) forcing MDs to refuse collaboration with naturopathic, chiropractic and osteopathic physicians in the co-management of patients; and 4) denying hospital access to naturopathic, chiropractic and osteopathic physicians.5-7 Although allopathic suppression of osteopathic medicine largely has ceased, intentional suppression and misrepresentation of chiropractic and naturopathic medicine is an ongoing problem that occurs on a daily basis.8 The bias, selective ignorance and intentional misrepresentation directed against naturopathic medicine by so-called "scientific" and "objective" medical groups and individuals is intense and unrelenting, and this tainted data is forwarded to the public and policy makers, who then act upon and codify the AMA's self-serving interests.9-12

Documentation of Current Anti-Naturopathic Action

In June 2006, the AMA declared war on the naturopathic profession by making public its commitment to forcibly oppose licensure and healthcare delivery by naturopathic physicians. This was posted on the AMA Web site13 and then quickly removed; however, the document outlines a resolution that the AMA's position will be one of "opposing the licensure of naturopaths to practice medicine." As of June 28, 2006, details of this resolution are available here and include the AMA's resolution to oppose naturopathic medicine, as well as its commitment to spend thousands of dollars to accomplish this mission. Again, quoting directly from the AMA website:

"RESOLVED, That our American Medical Association work through its Board of Trustees to outline a policy opposing the licensure of naturopaths to practice medicine and report this policy to the House of Delegates no later than the 2006 Interim Meeting. (Directive to Take Action) Fiscal Note: Implement accordingly at estimated staff cost of $10,836."

Other groups, such as the Minnesota Medical Association14 and New York State Academy of Family Physicians,15 also have publicly vowed to oppose the licensure of naturopathic physicians. While it's clearly a restraint of trade and an attempt to limit competition, the stated arguments that these allopathic groups use to justify their opposition to natural medicine is that 1) they are altruistically interested in maintaining quality of care; 2) that they are acting on behalf of ensuring patient safety; and 3) that quality of education is what defines excellence in allopathic medicine. As documented below, none of these are valid justifications for restricting the choice that patients should have in seeking and obtaining healthcare nor for denying naturopathic physicians their earned right to deliver healthcare.

Quality of Care is NOT the Real Issue

The AMA and other allopathic medical groups purport to act on behalf of "public safety" by restricting other healthcare professions; this is inconsistent with the facts that show allopathic/medical treatments kill approximately 3,500 American patients per week and that many natural treatments are comparatively safer and more effective.

According to internal reviews by allopathic researchers and epidemiologists, allopathic/MD physicians commonly deliver care that is "substandard"16 and which poses "serious threats to the health of the American public."17 If the AMA and other medical groups were serious about "quality of care," they would start by improving the care delivered by medical doctors to end the danger posed to the American public. The "accidental side-effect" killing of 3,500 Americans per week as a result of allopathic drug- and surgery-based medicine is a national catastrophe that has received insufficient attention.

Patient Safety is NOT the Real Issue

Drug interactions, drug "side effects," prescription errors, unnecessary surgeries, nosocomial (hospital-acquired) infections and "hospital errors" are a leading cause of death in America. The number of deaths due to "medication errors" more than doubled from 1983 to 1993, possibly due to the implementation of "managed care" which resulted in a shortening of patient visits and thus required doctors to make faster - and more often erroneous - decisions.18 Lazarou et al19 published a landmark report in the Journal of the American Medical Association in 1998, showing that hospital-supervised administration of drugs leads to adverse effects in more than 2.2 million American patients and directly results in more than 100,000 deaths, thus "making these reactions between the fourth and sixth leading cause of death." An article by Starfield,20 also published by the American Medical Association, documented that allopathic medicine is the third leading cause of death in America after heart disease and cancer; this article can be paraphrased as stating, "iatrogenic causes" result in "225,000 deaths per year" constituting "the third leading cause of death in the United States." Other estimates have been more conservative, such as the 1997 review by Holland and Degury21 in American Family Physician, wherein the authors note, "Recent estimates suggest that each year more than 1 million patients are injured while in the hospital and approximately 180,000 die because of these injuries. Furthermore, drug-related morbidity and mortality are common and are estimated to cost more than $136 billion a year." Thus, according to these authoritative reviews, we can reasonably conclude that not less than 110,000 and up to 225,000 American patients are killed every year by adverse drug effects, hospital errors and other "side-effects" of allopathic medicine.

Using an average of 180,000 American deaths per year, we see that allopathic/MD medicine kills 493 American patients per day, equal to approximately 3,500 deaths per week. Placing this into a public health context, we see that more people die every year from medical treatment than from cerebrovascular disease (168,000), diabetes (69,000), influenza or pneumonia (65,000).22 If it were not for the politics involved - that is, if allopathic iatrogenesis (harm to patients caused by medical doctors) were an infectious disease rather than a consequence of professional error - major public health campaigns would be directed to alert the public about risk-reduction measures for this underappreciated major cause of death. Likewise, medical organizations such as the AMA would fight vehemently for improved patient care, rather than focusing on either 1) limiting malpractice liability for allopathic doctors sued for harm or negligence; or 2) suppressing healthcare delivery by other professionals. Interestingly, using this average of 180,000 unnecessary deaths per year caused by medical interventions, with 493 Americans dying every day from "medical care" far surpasses the number of deaths caused by the September 11, 2001 terrorist attacks on the World Trade Center. Thus, if the AMA and other medical groups were serious about "patient safety," they would start by radically overhauling the American healthcare system to stop the death and injury caused by medical doctors.

Quality of Education is NOT the Real Issue

Recent authoritative publications published by the AMA itself have stated that "medical education is failing to prepare students adequately for their future practice"23 and that medical education "is currently being held together by peanut butter and bubble gum"24 No less than four consecutive studies have documented that most allopathic medical doctors (MDs) are incompetent when it comes to diagnosing and treating musculoskeletal problems and disorders, such as back pain and shin splints.25-29

Part of the problem with the public perception of naturopathic education comes from sycophantic psuedoexperts who claim to represent the truth when discussing topics of which they know little. Whether this comes from selective ignorance or intentional misrepresentation cannot be readily discerned, but the effects caused by misleading the public, other healthcare professionals and government policymakers are the same - all of these groups are mislead into undervaluing the quality of naturopathic education. For the last several years, the AMA has lambasted the chiropractic profession based on the findings of educational deficiencies found in 1968 - nearly 40 years ago!30 The AMA has to use such outdated "research" to make its feeble case because if they looked at more current research they would see that naturopathic education generally is comparable and occasionally superior to allopathic education.31-33 This becomes even more true if we follow, for example, research published in the AMA's journal showing that dietary interventions should be used before drugs for the treatment of high cholesterol;34 allopathic medical doctors receive essentially zero training in nutrition whereas naturopathic doctors are well versed in basic and clinical nutrition. If the research shows dietary interventions should be used before drugs for one of the most common problems encountered in clinical practice, then would not patients be best served and protected if they were allowed expedient access to the doctors with the most training in these interventions? This is merely one example of how healthcare policy has not kept pace with ongoing research.

Among popularizers of natural medicine, Dr Andrew Weil has received much fanfare as a representative of "alternative medicine" although his authentic credentials and clinical experience as a practicing clinician in this field are sparse; he has not attended - let alone graduated from - a college or university that trains doctors in the intricacies of natural medicine. His latest misrepresentation of naturopathic medicine was published in the April 2006 issue of Prevention magazine in his description of the differences between allopathic (MD), osteopathic (DO) and naturopathic (ND) education. While he states correctly that the first two years of these 4-year programs are similarly immersed in the basic sciences of anatomy, physiology, biochemistry and the like, he misleads his readers by characterizing the last 2 years of naturopathic medical education as being limited to "herbal medicine, massage, nutrition, and other natural therapies."35 He oversimplifies and thus undervalues naturopathic medical education by excluding the important details that naturopathic education also includes training in pharmacology, immunology, oncology, obstetrics and gynecology, endocrinology, psychology, minor surgery, urology, gastroenterology, medical procedures, orthopedics (in contrast to many allopathic medical schools) and rheumatology. I know from my experience of having taught orthopedics36 and rheumatology37 for the naturopathic medicine program at Bastyr University, that our training in these subjects was of high quality, inclusive of and extending beyond what commonly is taught in allopathic medical schools. Furthermore, Dr Weil's use of the word "conventional" to describe today's allopathic MDs is erroneous and myopic; allopathic medicine as we know it today has only existed for about 60 years of the 500-2000 years that we refer to as "civilization" and only a fraction of humans' multimillion year history! Diet, exercise, and other natural treatments have been what sustained cultures for millennia; only when societies depart from the common sense of these means does the overall health decline to such a level that crisis care medicine is needed by the majority of the population just to sustain existence.38

Another recent article again shows the extent to which MDs erroneously are presumed to be experts in everything. Dr. Peter Eupierre, president of the Illinois State Medical Society, recently stated, "Real diseases require real medical treatments, but naturopaths are neither trained nor capable of diagnosing and treating physical ailments."39 His comment implies that naturopathic physicians are defective human beings "incapable" of diagnosing and treating physical ailments. He has obviously failed to assimilate the research showing that, according to articles published by the American Medical Association, his allopathic/MD training failed to prepare him and his colleagues for clinical practice23-24 and that most medical doctors are neither trained nor capable of diagnosing and treating physical ailments.25-29 Dr. Eupierre goes on to arouse fear by again misrepresenting the facts when he states that licensing NDs would "allow people not medically trained to practice medicine, potentially putting Illinois patients at risk."

As if blinded by the pharmacosurgical paradigm he learned in medical school, Dr. Eupierre assumes that "medical training" and "medical treatments" are inherently superior to other treatments, including those used commonly by naturopathic doctors, such as diet, exercise and the tailored use of natural medicines. His claim is refuted by published research such as that in the American Journal of Managed Care, wherein patients who used a multicomponent prevention program that included 1) twice-daily meditation; 2) daily yoga; 3) herbal dietary supplements; and 4) "recommendations for diet and daily routine" benefited by experiencing improved health, less medical expenses and fewer medical interventions than patients who were relegated to "conventional medical treatment;" in the group receiving natural treatments, total medical expenses were reduced by 59 percent over 4 years and by 63 percent over 11 years. Hospital admission rates were reduced 11.4-fold for cardiovascular disease, 3.3-fold for cancer and 6.7-fold for mental health and substance abuse.40

Dr. Eupierre also fails to express his awareness and appreciation that natural treatments are the most effective treatments available for chronic hypertension, which is a common problem in clinical practice as well as a multibillion-dollar medical business in industrialized nations such as the U.S.41 The most effective treatment ever documented for this condition is doctor-supervised dietary restriction, a technique researched by the chiropractic doctor Alan Goldhamer; the intervention is safe, remarkably effective, and it also helps to reduce long-term medical expenses.42-44 Relatedly, supplementation with the nutrient CoQ10, a treatment commonly employed by naturopathic physicians, safely and effectively reduces blood pressure in hypertensive patients without the adverse effects common when chemical drugs are used to lower blood pressure.45-47 Whether from selective ignorance or intentional misrepresentation, slander against natural treatments is commonly worthless except when used as a tool to arouse fear in patients and politicians, the vast majority of whom are unaware that medical side-effects kill 3,500 Americans each week. It's truly amazing that these researchers and so-called "experts" can remain selectively ignorant of the adverse effects and unnecessary deaths caused by their own allopathic profession even when such facts are consistently documented in such "mainstream" journals as Quality and Safety in Health Care, The New England Journal of Medicine, The Lancet, Journal of the American Medical Association, and American Family Physician.

Suppressing Competition Keeps Quality Down and Prices High

Suppressing licensure for other health care providers contributes to America's crisis shortage of health care providers and keeps health care expensive due to restriction of trade; as recently reported in by the Los Angeles Times, "The number of medical school graduates has been virtually flat for 25 years while demand has surged. A lurking doctor shortage threatens to create a national health care crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases." The AMA is contributing to this crisis and the unbearable escalation of health care costs through its actions in limiting access to other health care providers. American health care would be more effective, more affordable and safer if naturopathic physicians were fully integrated into the health care system rather than being politically excluded (e.g., restrictive licensure laws48) or functionally excluded (e.g., discriminatory CPT codes and HMO policies49) by a system of drug- and surgery-based health care that financially depletes the people,50 business,51 and communities of our nation52-53 while failing to deliver consistently competent health care54-56 and cost-effective nationwide health improvements57 that are proportional to the continuous increase in spending.58

Abdication in the Natural Medicine Community

Allopathic usurpation is one problem (discussed previously59); abdication by the naturopathic and natural medicine communities also contributes to the imbalance of power.

National naturopathic organizations have done a wonderful job of merely surviving - and now thriving - under the heavily funded hand of the pharmaceutical industry and its allopathic representatives. Perhaps due to comparatively limited funding, ND organizations have been meek in their resistance to MD groups and have generally used a "go along to get along" approach rather than a more assertive tact that would probably be more effective and more expensive. Despite the superabundance of research showing the effectiveness-affordability-safety of "naturopathic" treatments and the inefficacy-expense-risks of relying on the allopathic "drugs and surgery" model of health care, ND groups have been meek while drug/medical groups steamroll the profession and our nation's opportunity to take advantage of changing paradigms in health care. To the extent that ND groups can take a more empowered stance, I can only hope that they will choose to do so. Being meek and gentle is how sheep get eaten by wolves. There is a place for collaboration, and there also is a place for establishing and defending boundaries and being assertively confident - the latter is only barely starting to occur in the naturopathic community.

Meanwhile, the natural foods and nutritional supplement industry is growing exponentially, yet comparatively little money flows in the direction of pro-naturopathic legislation. Naturopathic doctors collectively sell millions, if not billions of dollars, in nutritional supplements, but the very nutritional companies that rely on the naturopathic marketplace are modest in supporting the expansion of the very profession upon which they rely. Company A does not want to contribute to naturopathic expansion given that there is no guarantee that the newly licensed naturopathic physicians would not simply buy more supplements from Company B. This myopic selfishness fails to apprehend that if the naturopathic profession were nationally licensed (based on funding from the nutritional supplement industry) then all of the nutritional supplement markets would expand exponentially and the companies would easily recoup their respective investments. Funding the expansion of the naturopathic profession is the most effective way for nutritional companies to guarantee an expansive future marketplace.

Like the American public in general, politicians and policymakers should receive a balanced input of information when evaluating health care options and should not presume that "medical" treatments, education and safety are superior to those of other health care providers. The exorbitant expenses, high risk and poor outcomes associated with overuse of chemical drugs and surgical procedures are well documented; adverse effects from "medical care" kill approximately 3,500 Americans each week. The treatments offered by naturopathic doctors are comparatively safer, less expensive, and often more effective. Increased utilization of non-allopathic physicians is expected to improve nationwide health outcomes while reducing the burden of medical expenses, injury and unnecessary deaths because the interventions most often utilized by naturopathic physicians are non-invasive, low-cost, patient-implemented and well-supported by scientific studies.60

References

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  55. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003 Jun 26;348(26):2635-45. "Participants received 54.9 percent (95 percent confidence interval, 54.3 to 55.5) of recommended care...CONCLUSIONS: The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public."
  56. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. 1991. Qual Saf Health Care. 2004 Apr;13(2):145-51; discussion 151-2. "CONCLUSIONS: There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care."
  57. Christopher Murray MD PhD, Director of World Health Organization's Global Program on Evidence for Health Policy, click to view it online. Accessed July 12, 2004. "Basically, you die earlier and spend more time disabled if you're an American rather than a member of most other advanced countries."
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  59. Vasquez A. "Allopathic Usurpation of Natural Medicine: The Blind Leading the Sighted." [Editorial] Naturopathy Digest 2006, February.
  60. Vasquez A. The Importance of Integrative Chiropractic Health Care in Treating Musculoskeletal Pain and Reducing the Nationwide Burden of Medical Expenses and Iatrogenic Injury and Death: A Concise Review of Current Research and Implications for Clinical Practice and Healthcare Policy. The Original Internist 2005; 12(4): 159-182. Click to view it online.

About the Author: Dr. Alex Vasquez graduated from Western States Chiropractic College in Portland, Ore., in 1996, and then enrolled in the naturopathic medicine program at Bastyr University. By the time he graduated from Bastyr in 1999, Dr. Vasquez had published 13 articles in magazines and peer-reviewed medical journals and was a recognized authority on disorders of iron metabolism. Dr. Vasquez was later appointed to teach rheumatology, orthopedics, and radiographic interpretation at Bastyr. For family reasons, Dr. Vasquez returned to his hometown of Houston in 2002 and started a new private practice of natural medicine.



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