It’s been an interesting couple of weeks since part one of this critique of Britt Marie Hermes Change.org petition was authored. She seemed genuinely rattled by a single blog post, while not addressing a single point that was brought up in the original article. It seems instead of talking facts, she’d rather play a game of insults. That’s not the way this works. We’re talking evidence and data.

Up to this point in time no one had called her out on her misrepresentations, lies, and exaggerations. This was probably out of fear. Mrs. Hermes and her followers have been harassing N.D.’s on social media and even personally. Most N.D.’s have practices with public faces that are an easy target for harassment. That fear of harassment isn’t unwarranted. Here is an email sent to this blog from one of her supporters:

That’s what I call reasonable debate! The coward who wrote that has ties to the sciencebasedmedicine.org site that originally promoted Mrs. Hermes and continues to promote her work.

If you missed the first post on Britt Marie Hermes’ Change.org petition, it’s worth a read, but here is a summary of the key points.

1. Mrs. Hermes lied or mislead about her location on the petition – she is currently in Kiel, Germany getting a masters degree, but lists her location as the United States.
2. N.D.’s have more hours of training then N.P.’s or P.A.’s and equal hours of training to M.D.’s. Residency requirements are the same as N.P.’s and P.A.’s (voluntary). Both N.P.’s and P.A.’s have prescribing rights in many states.
3. The California Medical Society dropped their opposition to California ND license after vising Bastyr and seeing the quality of the education.
4. Bastyr students do not have to “master” homeopathy, and do not have to use it in the clinic. Homeopathy is used as a diversion for a real debate on naturopathic medicine. It is 3 classes, 9 hours total, or less then 3% of the classroom hours. Many M.D.’s use homeopathy. It’s evidence is equivocal.
5. Many, many trials show the efficacy of various botanical medicines. Botanical medicines work biochemically just like pharmaceuticals. Type your favorite herb into Pubmed. The same is true of balenotherapy, “therapies involving heat and water”. Lots of research there.
6. She leaves out lots to her convenience – the fact that N.D.’s are trained in pharmaceuticals, the fact that N.D.’s have 5 classes on diet and nutrient therapies, and 3 classes in counseling. The latter 2 being series being absent in M.D. (and N.P./P.A.) curriculums.

Today’s post is going to fact check the end of her post – the citations

Four things are clear from going over the citations:

1. She is shamelessly self-promoting using the “data and expert opinion” headline as a cover. She is the main source of “data and expert opinion” in three of the sources.
2. Most of the citations are opinion blogs including four from the sciencebasedmedicine.com site whose shill wrote this blog and told the author to “just go away, wither, and die”.
3. The primary research cited (the research published in peer reviewed journals) is cherry picked and all sources are based on data that is over 10 years old.
4. She leaves out important randomized controlled trials supporting naturopathic medicine that are published in some of the top medical journals in the world. This research is more recent then any of the citations she used and would invalidate not just her change.org petition, but the whole persona she created after being unsuccessful as an N.D.

I’ll explore these points in further detail below:

Atwood, Kimball C., IV (2003). “Naturopathy: A critical appraisal”. Medscape General Medicine 5 (4): 39.

Atwood IV, Kimball. C. (2004). “Naturopathy, pseudoscience, and medicine: Myths and fallacies vs truth”. Medscape General Medicine 6 (1): 33.

• The first two citations of her petition are from the same M.D., both written in 2004. His main point is that naturopathic medicine hasn’t been studied, which at the time was true. At the time of publication there were no RCTs (Randomized Controlled Trials) of general naturopathic care. This is a pair of old articles, from a single person, who’s assertions just aren’t true anymore. Mrs. Hermes doesn’t include the latest important primary research on naturopathic medicine because it would invalidate her whole point and persona. This is research that is peer reviewed by M.D.’s and published in quality medical journals. Links to this research will be included at the end of this article.

Barrett, Stephen (2013). “A close look at naturopathy”. QuackWatch.

• Quackwatch as a source? Really? An opinion blog, not primary research.

Wilson, K. (2005). “Characteristics of Pediatric and Adolescent Patients Attending a Naturopathic College Clinic in Canada”. Pediatrics 115 (3): e338–e343.

• This citation is based on a 2002 survey that shows the pediatrics that present at a naturopathic clinic have a lower vaccination rate then the general pediatric population. This isn’t surprising considering that many people seek out naturopathic care after bad experiences with M.D.’s or from false notions about the conventional medical system. What it shows is the opportunity for N.D.’s to bring people “into the system” that would never see a conventional provider. N.D.’s are trained in the benefits of vaccines and vaccine administration and can be a conduit to better vaccination rates. See N.D.’s for vaccines website (http://www.ndsforvaccines.com/)

Boon, Heather S.; Cherkin, Daniel C.; Erro, Janet; Sherman, Karen J.; et al. (2004). “Practice patterns of naturopathic physicians: Results from a random survey of licensed practitioners in two U.S. States”. BMC Complementary & Alternative Medicine 20 (4): 14.

• This is essentially a data gathering study that shows how N.D.’s practice. It’s worth a read, and certainly there is nothing in here to support the contents of the change.org petition. From the conclusion: “Overall, naturopathic physicians spend more than twice as much time with patients as conventional physicians at each visit (40 minutes vs. 14 minutes) [16], permitting more time to discuss patients’ concerns and counseling/education about lifestyle issues such as diet.”

Busse, Jason W.; Wilson, Kumanan; Campbell, James B. (2008). “Attitudes towards vaccination among chiropractic and naturopathic students”. Vaccine 26 (49): 6237–6243.

• The full text is behind a paywall, so there is no way to look at the data. The main flaw in this study is that it is cross sectional, which means the first year survey participants weren’t followed to see how their views changed. It just shows that first year students were more for vaccines then final year students at that particular point in time. It’s also based on old data.

Wilson, Kumanan; Mills, Ed; Boon, Heather; Tomlinson, George; Ritvo, Paul (2004). “A survey of attitudes towards pediatric vaccinations amongst Canadian naturopathic students”. Vaccine 22 (3-4): 329–334.

• Again, behind a paywall. It has the same flaws as the other study. It’s cross sectional, meaning it takes a snapshot at a point in time and then tries to make a conclusion based on that differences in that snapshot. To get valuable data they should have surveyed the incoming students and then followed then each year to see how their attitudes changed. Also, the data used is at least 15 years old and would be distinctly different then if done today.

Downey L, et al. (2010). “Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers.”. Matern Child Health J. 14 (6): 922–30.

• This doesn’t study naturopaths directly, but any patient that had contact with a CAM provider – massage therapist, acupuncturist, etc.. It  shows that patients that visited CAM providers were more likely to acquire a vaccine preventable disease. It’s retrospective, and correlational. Did the parents have the bias against vaccines before visiting the CAM provider which is why that sought CAM in the first place? (see my thoughts above about well-trained N.D.’s being a way to bring vaccine-hesitant parents “into the system”) Being a retrospective, non-randomized study there is no way to tell. Very weak source.

That’s it for the primary citations. Cherry picking at its worst. Skip to the last part of this article for the much stronger primary research on naturopathic medicine she intentionally left out.

“Testimony in Opposition to H. 1992 and S. 1205, An Act to Create a Board of Registration in Naturopathy”. Massachusetts Medical Society. Massachusetts Medical Society.

• No citations, an opinion piece. Medical societies across the U.S. have opposed N.D. licensure because they see N.D.’s as competition. It’s purely political and not based on the data. The national position of the American Medical Society is to oppose licensure of Naturopathic Doctors. To the credit of the California Medical Society, when they visited Bastyr and saw the quality of the education, they dropped their opposition.

The rest of her citations are blogs. Anyone can post a blog. It’s not peer reviewed before being published, and the selection of blogs and other secondary sources Mrs. Hermes cites shows an obvious bias.

Lipson, Peter. (2016). Naturopaths: Fake Doctors in White Coats? Forbes.

• Forbes has continuously published articles trashing naturopathic medicine. They are not objective. Simply looking at the title shows this.

Caulfeild, Timothy. (2013). Don’t legitimize the witch doctors. National Post.

• The author of the article says N.D.’s shouldn’t be regulated because they are “witch doctors”. Objectivity anyone? Nope. He then spends the rest of the text trashing homeopathy as his justification for not regulating naturopaths. Homeopathy is 3% of naturopathic medical education and isn’t required to be practiced. He also suggests there is no primary research supporting Naturopathic Medicine, which of course there is, and which Mrs. Hermes conveniently omitted from her list of sources.

Palmer, Brian. (2014). Quacking All the Way to the Bank: Naturopaths are winning insurance coverage for medical nonsense. Slate.

• Quack. Witch Doctors. Fake Doctors. Are you starting to see a pattern here? Dudes with blogs that like to write catchy headlines and have an agenda. These aren’t clinicians (M.D.’s, D.O.’s, N.D.’s, etc..) These are keyboard warriors with an agenda. Here’s the first sentence from the article “Legislators in Washington state refuse to live in a world where only the wealthy can afford care from poorly trained health care providers who practice unproven medicine” He refuses to link (like the other blog writers cited) to the primary research that shows the efficacy of naturopathic medicine, as well as the cost savings to the health care system (over $1,000) per patient/per year that happens when people see a naturopathic doctor.

4 citations from sciencebasedmedicine.org. This is the blog which “debuted Mrs. Hermes”, and from which I got the lovely email that told me to “crawl into a hole and die. Fuck ND.” Their agenda is purely anti-CAM and anti-science. Science looks for truth through objective testing. Naturopathic medicine when looked at under this lens shows that it works.

Various authors. Naturopathy vs Science. ScienceBasedMedicine.org.

Hermes, Britt. (2015). ND Confession, Part 1: Clinical training inside and out. ScienceBasedMedicine.org

Hermes, Britt (2015). ND Confession, Part II: The Accreditation of Naturopathic “Medical” Education. ScienceBasedMedicine.org.

Hermes, Britt. Naturopathic Diaries.

The last 3 being herself as the “source”.

Mrs. Hermes heading for all of this is “data and expert opinion”. The lack of understanding of what can be considered data and “expert opinion” hints at why she was an unsuccessful practitioner. This author is familiar with the research community and if she was to present a similar list of citations, in the guise of being objective, for a research paper she would summarily be failed and kicked out of the program.

The primary research that was left out

There is a strong body of high quality evidence that shows that naturopathic medicine is effective and safe. These are 4 randomized controlled trials (RCTs) of naturopathic medicine. This means the participants don’t know if they’ll be getting the treatment being studied, in this case naturopathic care, or a placebo.

Included is also a cost effectiveness analysis of one of the trials.

The journals that 3 of the RCTs are published in, PLos One, and CMAJ (Canadian Medical Association Journal), are both top quality journals. In order to be published the research has to be reviewed by a team of medical doctors for a number of quality factors. They look at the methodology, they look at the data collection and analysis, they look at the conclusion to see if it makes sense based on the data. All of these studies passed muster and were publushed.

None of the primary research provided by Mrs. Hermes were RCTs. None of the primary research provided by Mrs. Hermes was on the efficacy of naturopathic medicine. They were all surveys on a single topic – vaccines. All, but a single source more then 10 years old. Cherry picking data, leaving the high quality data out of her “citations list”. It’s not science, it’s not looking at evidence, it having an agenda and doing what it takes to make a point. Highly unethical, and it speaks to why she failed as an ND.

Here is the primary research on naturopathic medicine that Mrs. Hermes conveniently omitted:

Seely D, et al. (2013). “Naturopathic medicine for the prevention of Cardiovascular Disease: a randomized clinical trial“. CMAJ. 185 (9):E409-16.

Herman PM, et al. (2014). “A naturopathic approach to the prevention of cardiovascular disease: cost-effectiveness analysis of a pragmatic multi-worksite randomized clinical trial“. J Occup Environ Med. 56 (2):171-6.

Cooley K, et al. (2009). “Naturopathic care for anxiety: a randomized controlled trial“. PLos One. 4 (8):e6628.

Szczurk, et al. (2009). “Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial“. Arthritis Rheum. 61 (8): 1037-46.

Szczurko, et al. (2007). “Naturopathic care for chronic low back pain: a randomized trial“. PLos One. 2 (9):e919.

All of these studies show that naturopathic medicine is both safe and effective. All are randomized, the strongest type of trial. CMAJ. PLos One. – peer reviewed, highly respected journals. A future post will talk further about these randomized trials and what the data shows.

Intentional omissions, lies and bias

You can’t claim to be “science based” and then ignore the science that you don’t agree with. That’s practicing anti-science medicine just for the sake of being right. Mrs. Hermes would be kicked out of her master’s program if the citations list for her masters thesis looked anything like the one she included in her change.org petition – citing herself, omitting data that doesn’t support her agenda. It’s a poor attempt at a smear campaign.

This change.org petition has been the culmination of a year of effort to slander and discredit the profession while trying to build a “personal brand” as an expert on Naturopathic Medicine. With a little work Mrs. Hermes motives become clear. Instead of engaging in reasonable discussion on facts and data she would rather engage in slander, insults, and name calling . She continuously uses the words pseudoscience, and quackery to a comical effect. It shows she absolutely has an agenda and isn’t willing to objectively look at both the benefits and the real criticisms that need to be directed toward naturopathic medicine.

Britt Marie Hermes, author of The Naturopathic Diaries, started a Change.org petition with the title “Naturopaths are not doctors, stop legitimizing pseudoscience”.  In this post we’re going to get to the truth and will be fact checking the claims she makes.

Taking it from the top:

Pretty bold claim, especially coming from someone that was an unsuccessful Naturopathic Doctor. There is a problem though. She lists her location as being the United States. She currently lives in Germany as she has stated in her blog multiple times. Before even leaving the headline, we have a lie. It’s not clear why she wanted to lie here, but it may be because she is petitioning the U.S. government for legislation that just effects U.S. citizens while residing in a foreign country. Seems pretty shady. Of course there may be merit still to her claims, but starting off with a lie before anything has even been written is not a good way to start.

Let’s see what we have next:

Taking a look at the course description from Bastyr, we get an objective view of the curriculum. Every naturopathic medical student has a number of science based prerequisites they have to take (chemistry, physics, psychology, and biology). Once accepted they have training that is heavily science based. They have gross anatomy (cadaver dissection lab) for a whole year, physiology (the mechanics of how the body works), and with the integrative curriculum histology, biochemistry, anatomy, are all integrated by body systems.

The author of this article doesn’t have the time to do a complete comparison of each profession in this post, but ND’s have more training then NP’s (nurse practitioners) or PA’s (physicians assistants) and equal training (hours wise) to medical doctors. Both MD’s and ND’s have science based educations. MD’s are required to have 3 years of residency, ND’s are not required to have a residency although residencies are sought out by many students. Residencies for Naturopathic Doctors will be addressed in a future post. A more through comparison can be found here.

It’s worth asking – If the training of Naturopathic Doctors is so poor, why are they being accepted by their conventional peers? If they weren’t well trained then their medical doctor colleges should be able to see right through their lack of competency. The opposite is true. The California medical society was originally opposed to the licensing of naturopathic doctors, but after visiting Bastyr and seeing how the students were being educated,  they dropped their opposition and ND’s became licensed in California. I would trust a society of medical doctors and students happy with their education over one unsuccessful naturopathic doctor with a clear axe to grind.

There are many successful practitioners that have come from Bastyr, helping tens of thousands of patients every day, while working adjunctively with conventional providers. Cancer Treatment Centers of America employs Naturopathic Doctors, because of their ability to provide quality adjunctive care. If naturopathic doctors were not trained similarly to conventional providers they would not be able to work in adjunctive care environments like that at Cancer Treatment Centers of America and many integrative clinics across Canada and The United States.

Moving on – Paragraph #3

Homeopathy is going to be a controversial topic until either a mechanism is proven to show how it works, humanity ends with an asteroid hitting the earth, or what looks increasing likely when Donald Trump is elected president (apologies to Donald Trump supporters, but having his temperamental finger on the nuclear button scares the shit out of this author). Overall, the data on homeopathy isn’t clear. One meta-analysis will show that it is more beneficial then placebo, the next shows it’s no more then placebo. What is clear is that many people, both medical doctors, and naturopaths use homeopathy because it has been shown to be effective clinically. To turn a discussion of naturopathic medicine into a discussion on homeopathy is false. Students take 3 classes on homeopathy and aren’t required to use it, let it alone “master it”, once they are in the clinic. Mrs. Hermes knows this having attended Bastyr, and her saying “Naturopathic students are required to master..” falls somewhere between intentionally misleading and an outright lie.

Herbs are natural sources of chemicals that have a physiological effect on the body. Herbs typically have many active chemicals. Pharmaceuticals are a single chemicals (or sometimes 2 or 3) that have a physiological effect on the body.  Herbs = chemicals that have a physiological effect on the body. Pharmaceuticals = chemicals that have a physiological effect on the body. It’s ridiculous to use herbalism as a pejorative. And to stay that herbs haven’t been studied is just bullshit. Type your favorite herb into pubmed and see what comes up.

Chiropractic-like manipulations are taught. Big deal. The author of this article isn’t clear on the data behind manipulations, but performed correctly while screening out patients with contraindications (which are taught in the physical manipulation classes) makes this a moot point.

Therapies involving heat and water…. wooo. She’s drawing at straws here. Germans and many Europeans have integrated balneotherapy (water therapy) into their lives. In fact there are over 12,000 journal articles supporting its use. I bet since being in Germany Mrs. Hermes has used water therapy. If she hasn’t, she should get on it. Not all things that effect human health and wellness are pharmaceuticals.

She also leaves out the fact that naturopaths are trained in pharmaceuticals, diet and nutrition, and counseling. That’s  convenient isn’t it? If all sides were presented that makes her argument invalid. Like most of the things she’s written, she hasn’t wanted to present facts, so she has omitted important information that would refute her arguments.

This post will be continued in Part 2.

The author of this post expects attempts to change parts of the petition after this is posted. Screenshots have been taken of the way the petition originally appeared on 06/02/16 at 12:30PM PST and will be linked to the end of part 2.