Tuesday, July 23, 2013

Naturopaths & Alternative Or Naturopathic Pharmacology


Once more an anonymous person who says s/he is an ND has told me that naturopaths are trained in pharmacology and the use of prescriptions drugs just like primary care MDs are. 
For starters let me make it clear that I have no reason to doubt that s/he has earned a degree from an accredited ND school. In fact everything s/he has said to me sounds as if that assertion is true but I have no way to verify it. 
I believe that s/he and many others who write to me anonymously saying they are licensed NDs and that they are trained in pharmacology and the use of prescription drugs really believe it. However, everything I know about naturopaths and everything they say makes me conclude that they are terribly and dangerously mistaken. Let me try to explain.
When I first developed argyria, I researched dermabrasion, a procedure in which the top layer of skin is literally sanded off, but I and the dermatologists I consulted dismissed it because we knew that silver was bound up so deep down in my skin that it couldn’t be sanded off. For that reason, we assumed that dermabrasion could not effectively treat argyria. Roughly twenty years later, I noticed that I had thin light lines on my skin which resembled scratch marks. While I’ve always been around dogs, cats, puppies and kittens, I didn’t remember ever being scratched. Any scratches I had gotten were so minor that they never bled. Suddenly it hit me. For twenty years I’d assumed that dermabrasion couldn’t help me, but IN MEDICINE YOU DON’T ASSUME. YOU TEST. 
I felt like the world’s biggest fool thinking that maybe I had been discolored all those years when I could have been “normal”. What if the silver could have been removed with dermabrasion? Just because the dermatologist couldn’t sand off enough skin to reach it with his little electric sander didn’t mean that the procedure wouldn’t cause a chemical reaction that would have an effect on the silver. For instance, the inflammation the dermabrasion caused might possibly result in forcing the silver out of my skin to a place where the body could eliminate it or where it wasn’t visible.
I knew I had to have a test patch done, something I should have had done 20 years before because IN MEDICINE YOU DON’T ASSUME. YOU TEST. 
Medical doctors who practice evidence-based medicine and scientists like pharmacologists know this exceedingly well. The years they spend doing and following research drills the lesson into them. They know that when you are dealing with a complex organism like a living human being that all kinds of unknown things take place inside the organism that can effect the person’s health and the way that drugs, therapies and toxins affect him. While many of these effects are predictable, many are not and experience has shown scientists time and time again that ASSUMPTIONS HAVE TO BE TESTED OBJECTIVELY TO SEE IF THEY ARE ACCURATE. Naturopaths who have only very recently been exposed to scientific or evidence-based medicine and who still aren’t engaged in scientific research haven’t learned this yet. They have over 100 years of catching up to do. A great many don’t even want to catch up. They are still very weary of scientific medicine and even afraid of it which is exactly why they want to use “natural” alternatives. 
But back to the little light lines on my gray skin. 
After calming down and thinking rationally, I decided to have a test spot on my skin dermabraded. However, by then I realized full well that even if it worked it wouldn’t help me because I would never let anyone sand my upper and lower eyelids so that if the silver were removed from the skin on the rest of my face I’d wind up looking like a raccoon, but by golly, by then the experiment wasn’t about curing me.  It was about seeing what effect dermabrasion has on argyria. Something I really wanted to know.
This urge to experiment to learn and to objectively test your suspicions to see if they are true is the most integral part of science, including scientific or evidence-based medicine and all the medical sciences like pharmacology, yet it is the very need to test rather than assume that drugs and therapies are safe and effective that separates naturopaths from scientists and medical doctors who practice evidence-based medicine. 
While I have no doubt that ND schools teach a subject that they label  “pharmacology”, that perhaps they even have people who have earned PhDs in pharmacology teaching the course and that they may even use pharmacology textbooks that medical scientists state are reliable, I don’t think that NDs are taught, understand or appreciate the medical science of pharmacology or any other science for that matter. If they did, they wouldn’t fail to comprehend the need to objectively test their assumptions and beliefs about natural drugs and therapies before routinely using them.
Here are just a few examples of NDs, as a profession rather than just a few individuals, routinely assuming that their assumptions are correct without ever testing them or checking to see if anyone else has.
Over 200 naturopaths licensed in the state of VT assumed that silver taken internally or put in the eye was safe and offered benefits. Why else would they have included it in their VT sanctioned Naturopathic Formulary?  http://rosemaryjacobs.com/naturopaths.html (Scroll to the bottom to see the formulary.)
Over 200 naturopaths licensed in VT assumed that cobalt, nickel and tin offered benefits when administered IV. They included them in their formulary too. 

I am not an MD or a medical scientist and was not about to take the time to research those items, but the idea of anyone shooting cobalt, nickel or tin into someone’s vein sounded really weird and dangerous to me, which is why I asked the newly appointed VT official charged with regulating licensed NDs in the state about the practice and expressed my concerns to him. 
(Scroll down to # 12, the letter from VT Health Commissioner, Harry Chen, MD, the VT NDs’ state regulator.) Specifically notice his statement:
“Tin is sometimes administered by naturopaths who believe tin can be used to treat baldness based on a few studies involving mice. The efficacy of this treatment has not been demonstrated in the medical literature. Tin is not an essential nutrient.”

As far as I’m concerned that is totally insane. No one trained in pharmacology will assume that something that has an effect in mice will have the same effect in humans or that it will be safe to use in humans. Scientists, or anyone who knows anything about the history and development of drugs, knows that you can’t  assume that a substance that works in a test tube will work and be safe in humans. Heck, they’ll even know that what is safe and effective in one species like a mouse may not be safe or effective in another species like dogs, cats or humans. That is why drugs aren’t approved simply based on studies that show they work in a test tube or that they are safe and effective in an animal model like mice. Everyone who knows diddle about evidence-based medicine and pharmacology knows that, but NDs don’t. That tells me that they know nothing about science or the science of pharmacology which is why I would label any pharmacology naturopaths learn in their accredited schools as Alternative or Naturopathic Pharmacolgy, something which is the opposite of the science of pharmacology.

Using tin intravenously to treat baldness in humans because of a few studies showing it worked in mice, even assuming the mice studies were good, without ever testing it in humans is totally irresponsible and crazy especially when baldness is not a disease and especially when it would be so very easy for naturopaths to conduct tests to determine if their assumption about it is correct. It would be so simple, easy and cheap to do experiments to determine if their assumption was true. Heck, I even know a few NDs who would be perfect test subjects. 

Dr. Chen did not address cobalt or nickel in his letter to me yet if you check the Memorandum at the bottom of this page, http://rosemaryjacobs.com/naturopaths.html, you will see that on his advice, in the interest of patient health and safety, they were removed from the formulary along with colloidal silver, silver and tin, and quite frankly I’m very certain that none of those things would have been removed if I hadn’t so aggressively pursued the matter. 

Including untested substances in their formulary certainly didn’t bother any of the NDs licensed by the state of VT all of whom have degrees from accredited naturopathic “medical” schools. Apparently it never occurred to them to test the things they included in their formulary to see if their assumptions about them were true or to even review the medical literature to find out if they had already been tested and found to be useless and/or toxic by scientists.  Worse yet, when I expressed my concerns, they didn’t investigate to see if I was right. They simply brushed me off. All of this convinces me that, contrary to what naturopaths believe, they know nothing about pharmacology, toxicology, science or evidence-based medicine.

In addition to learning something about prescription drugs in their “medical” schools, naturopaths are taught about classical homeopathy, botanical drugs and dietary supplements (natural medicines) and are expected to incorporate them all into their practices. Most NDs also sell these “natural remedies” to their patients. 

There is no objective evidence to support the use of any classical homeopathic remedy, and if there were, chemistry as we know it would be flushed down the drain because such remedies don’t contain active ingredients. They are well shaken sugar or water that homeopaths and naturopaths believe, but have never objectively demonstrated, have curative properties. It isn’t just pharmacologists, medical doctors who practice scientific medicine, and medical scientists who you will find rolling on the floor with laughter when they hear NDs claim that homeo remedies are medicine, chemists too find it so outlandish as to be preposterous. It is the antithesis of science. The antithesis of chemistry. Classical homeopathic “remedies” are things that people who understand chemistry or pharmacology, a very specialized branch of chemistry, simply would never use except as a placebo, a sugar pill the doctor knows is useless but which he gives a patient he can’t help to make him “feel better”. But NDs don’t use homeo remedies as placebos. NDs are taught and most believe that they really are medicine. If they understood pharmacology, they would never believe that.

Except for a very few diseases which are treated with specific vitamins, there is no evidence that crude botanical drugs and supplements offer benefits and lots of evidence that they cause harm. http://www.theatlantic.com/health/archive/2013/07/the-vitamin-myth-why-we-think-we-need-supplements/277947/. Yet they are an integral part of the practice of naturopathy. Why? Because NDs assume that Mother Nature offers cures but they never test the substances objectively to see if that assumption is true. What they do is mine scientific data bases to find studies showing that the natural drugs and therapies they believe in and assume are safe and effective are. They compile the results along with lists of the natural chemicals found in specific botanical remedies and mistake the results for pharmacology when what it really is is a smorgasbord of isolated study results. That’s called “cherry picking” - pulling together things that prove your claim without any regard to the accuracy or quality of the studies you cite or whether or not they are relevant to the claim you are making - are they lab studies, mice studies or human studies - all the while excluding anything you find that shows that your claims are wrong. While lawyers and naturopaths may get away with that. Scientists like pharmacologists can’t. They are required to present a large body of evidence - many good quality studies - that consistently give the same results before they can draw a conclusion. 

Here’s another example of what I call “Alternative” or “Naturopathic Pharmacology” taken from Textbook of Natural Medicine, 1999, 2nd edition, Pizzorno & Murray, which Bastyr, the naturopathic “medical school”, calls, “the gold standard in science-based natural medicine.” 

What follows are excerpts interspersed with my comments.

p. 775
Hydrastis canadensis (goldenseal) & other berberine-containing botanicals

The pharmacology of these plants is primarily discussed in terms of the activity of berberine. 

p. 776
Pharmacology
Berberine has demonstrated antibiotic, immunostimulatory, anticonvulsant, sedative, hypotensive, uterotonic, cholerectic, and carminative activity. Berberine’s pharmacological activities support the historic use of berberine-containing herbs. 

Berberine has shown antimicrobial activity against bacteria, protozoa, and fungi,…

[Comment: Ten references are given. None look as if it is to a study done in humans. Several of the publications are obscure. One is a book about herbs for the general public. NDs may mistake these references for evidence. Scientists never would. Scientists require a large body of solid studies that consistently give the same results, not a few obscure ones, some or all of which are of questionable quality, and when drugs are concerned, the studies have to be done in humans with a standardized substance.]

p. 778
It appears that berberine is effective in treating the majority of common gastrointestinal infections. The clinical studies have produced results with berberine comparable to standard antibiotics in most cases. In fact, in several studies results were better.

p. 779
Berberine has been shown in several clinical studies to stimulate the secretion of bile (cholerectic effect) and bilirubin. In one study of 225 patients with chronic cholecystitis, oral berberine doses of 5-20 mg three times a day before meals caused, over a period of 24-48 hours, disappearance of clinical symptoms, decrease in bilirubin level, and an increase in the bile volume of the gallbladder. 

[Comment: Cholecystitis is an inflammation of the gallbladder. I don’t see a citation to the study mentioned. They also recommend goldenseal for the treatment of trachoma, an infectious eye disease, cirrhosis of the liver and cancer. p.778-779.] 

p.780
The dosage should be based on berberine content. As there is a wide range of quality in goldenseal preparations, standardized extracts are recommended...

Now lets compare what the naturopaths’ gold standard textbook says about the pharmacology of Hydrastis canadensis to a few sources Mr. Google found.

University of Maryland. Accessed July 2013:

Excerpt:
Goldenseal (Hydrastis canadensis) is one of the most popular herbs in the United States, often combined with echinacea and sold to treat or prevent colds. But there's no evidence that it works. In fact, there's very little scientific evidence that goldenseal works to treat any condition… A substance in goldenseal, called berberine, does kill some kinds of bacteria and fungus in test tube studies. But scientists don't know if goldenseal would kill any germs in people.

NCCAM, the US government agency setup by Congressmen who were strong proponents of “alternative” medicine and “dietary supplements” and wanted the government to conduct studies they thought would show that their pet remedies and therapies were safe and effective.  Accessed July 2013:

Excerpts:
Few studies have been published on goldenseal’s safety and effectiveness, and there is little scientific evidence to support using it for any health problem.
Clinical studies on a compound found in goldenseal, berberine, suggest that the compound may be beneficial for certain infections—such as those that cause some types of diarrhea, as well as some eye infections. However, goldenseal preparations contain only a small amount of berberine, so it is difficult to extend the evidence about the effectiveness of berberine to goldenseal.
NCCAM is funding research on goldenseal, including studies of antibacterial mechanisms and potential cholesterol-lowering effects. NCCAM is also funding development of research-grade goldenseal, to facilitate clinical studies.

The Mayo Clinic on inflammation of the gallbladder or cholecystitis. Accessed July 2013: 

Now if you think that maybe UM, the NCCAM or the Mayo Clinic simply didn’t find the studies the NDs found, you’d be wrong. The scientific medical literature which includes things like drugs and natural products is indexed. Searching it and finding studies relevant to a particular topic is what medical doctors and scientists do all the time. It is what many of the people who posted the material on the 3 sites above do for a living.

Medical scientists like pharmacologists have and continue to study all kinds of plants and substances found in nature looking for active ingredients that offer benefits. They study them in the lab, in animals and in humans. They find many that have active ingredients, describe the ingredients chemically (most people have seen chemical diagrams of molecules) and explain what they discover those chemicals do, but they don’t assume that they are safe and beneficial or routinely use them as medicine until they have a large body of evidence consisting of many solid studies done in humans that consistently show that they offer benefits and are safe. In other words SCIENTISTS DON’T ASSUME. THEY TEST. That is the essence of science. The essence of pharmacology. The essence of scientific or evidence-based medicine. It is the very essence that NDs totally miss. 

I suspect that naturopaths learn a lot of chemical names as well as the chemical components of plants and drugs and what those chemicals do in test tubes and mice and erroneously assume that they do the same thing in people. I also suspect that they assume that when they learn all that that they are learning pharmacology, but that assumption is wrong. They completely miss the fact that until there are many good studies in humans consistently giving the same results that there is no pharmacology to learn other than their alternative, naturopathic pharmacology which is based on assumption not experiments. 

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