What is a naturopathic physician?
In states where they are licensed, naturopathic physicians are graduates of four year residential naturopathic medical schools, where they study both conventional medical sciences including pharmacology and minor surgery as well as the gamut of natural therapeutics such as acupuncture, clinical nutrition, spinal manipulation, etc. like their MD and DO counterparts, they are required to complete the same four years of pre-med, and must successfully pass national medical boards to acquire their license. One major difference between MD and naturopathic education is that the last years of MD training is mostly in hospitals and exposure to major surgery, whereas naturopaths focus on non-hospital care of chronic diseases and minor acute conditions.
How does naturopathic treatment of my thyroid condition differ from what a conventional endocrinologist might do?
Conventional endocrinologists are likely to treat hypothyroidism only with Sythroid or its generic which contains only one of the known thyroid hormones, are are likely to adjust your dose based on lab values only, giving little or no value to signs, and virtually no value to symptoms when adjusting your medication. Usually only the TSH lab value will drive the prescribing pattern of an MD. A naturopathic endocrinology approach, on the other hand, would definitely give serious consideration to signs and symptoms. And while a naturopath must run labs and take the results very seriously, they will include the results of the exam patient history, which leads to a more customized treatment plan. They are also more likely to use prescription glandular thyroid preparations which include all the thyroid hormones. It is common to address related issues such as diet, exercise, sleep patterns, stress, and other health issues such as adrenal fatigue which often have a bearing on thyroid health. Sometimes patients are convinced that their thyroid has not been cared for well by conventional doctors because they still have symptoms strongly associated with thyroid problems. If not for the more thorough visit to a naturopath they might never have discovered that they were actually suffering from another condition whose signs and symptoms overlap with hypothyroidism.
How is your practice evidence-based?
As a member of a medical profession, Dr. Barnett believes that the naturopathic principles which give his profession its identity must be tempered by scientific evidence. He believes that it is ultimately part of his Naturopathic Physician’s Oath (“I dedicate myself to the service of humanity as a practitioner of the art and science of Naturopathic medicine”). There are some in the naturopathic, chiropractic, and acupuncture profession who believe that evidence-based-medicine is a product of a mechanistic world view, which is using an overly narrow/restrictive view of science, deliberately designed to place such professions distinctively on the outside of the circle of science. As an integrative physician, Dr. Barnett does not participate in this interprofessional debate, which he believes is based more in economics and turf-war politics than what is in the best interest of patients and the public. As a doctor with one foot in alternative medicine and one foot in conventional medicine, he often finds himself in unfriendly waters by one or the other group. Many fellow naturopaths, for example, do not like his positive embrace of CDC immunization guidelines. Some patients are taken aback by his lack of enthusiasm about some aspects of alternative medicine that they may they favor. Endocrinologists may shake their head at his preference for glandular medications over Synthroid or its generic. But in almost every case, despite which side is critical, his positions are based on evidence and safety concerns for his patients and public health. He has come to the conclusion, for example, that the American Association of Clinical Endocrinologists pro-Synthroid / anti-glandular position is not based on an updated version of the scientific evidence. His experience in working in research has provided strong evidence that the very bias that science is supposed to minimize is much more difficult to eliminate than proponents of “science-based medicine” suggest, especially when it comes to the effects of powerful professional interests or high-powered industry. This fact should not stop us from using science to make clinical decisions, but must temper our approach. Conventional medicine practitioners tend to passively accept their profession’s guidelines as scientifically validated simply because they were taught so in medical school or by an continuing education speaker or drug company rep. I agree that for the most part they are practicing science based medicine, but not always, and the cookie cutter approach will not work for everyone. The integrative practitioner is more willing to go outside the guidelines to utilize approaches which are not advocated by medical specialty groups. This does not mean that these alternative approaches are by definition unscientific. In fact, most innovation comes from these kinds of doctors, who are more willing to, for example, prescribe a medication off-label. The medical profession’s progress would be greatly restricted if these doctors did not practice medicine. Naturopathic medicine is the profession most open to this kind of practice. The down-side of this openess is that buyer beware is more important here than in conventional medicine. You are less likely to predict the type and quality of care, and it is doubly important to rely on reviews and recommendations when choosing an integrative medicine doctor.