I sit on the board of several organizations, and these past several weeks, the topic of teaching naturopaths in regenerative medicine has come up. It was an important discussion as naturopaths have managed to get laws in several states allowing them to perform minor surgical procedures. I opposed this because of some substantial differences in training that impact the safety of patients. Let me explain.
A naturopath is a medical provider who is trained in natural healing. To me, they’re incredibly skilled in helping patients find natural ways to help chronic disease. For example, my kids and wife have seen a naturopath to help them with allergies. Also since I’m someone who often chuckles about how we traditional-medicine doctors and big pharma have screwed up medicine, the idea of a whole profession that thumbs its nose at both is very appealing. Finally, one of the core principles of naturopathic medicine is that the job of the physician is to ramp up the body’s natural ability to help itself. That’s very much in line with regenerative medicine.
This past decade, naturopaths have been pushing hard in various state legislatures to gain privileges that once was only accrued to physicians. One of those areas where they have been successful is the ability to perform minor in-office surgical procedures, like injecting muscle trigger points or taking out stitches. The rationale to allow this is that we still have a physician shortage in the rural areas of many states, and naturopaths may be able to fill some of that need.
On its face, all of this sounds reasonable. However, there has been some serious abuse on the part of naturopaths. For example, we’ve seen many this past few years add PRP and stem cell procedures that require liposuction and advanced spinal injections to their practices. The problem is that both of these procedures can be associated with serious complications and side effects. Take liposuction, where the intent is to disrupt and liquefy structural fat tissue and then suck it out. In the process, it’s possible to damage nerves and blood vessels or cause a severe life-threatening infection. Or consider a spinal injection. We’ve seen several cases where naturopaths performing blind injections have punctured the covering of the spinal cord causing a dural leak, and they were unable to recognize that the patient was suffering from a dural leak. Let’s delve into that specific issue a little deeper as it reveals stark differences in training between a naturopath and physician.
Much has been made by naturopaths that their training is now equivalent to that of an MD or DO physician. However, some of the issues that came up in the recent board discussion were reports of naturopaths missing common medical side effects of spinal injections, like a dural leak. In fact, naturopaths were not even able to understand that this was a possible complication of the spinal injection procedure they performed. So how is it possible with all of the hours that naturopaths claim they train that they’re not able to conceptualize or catch a simple and common complication of spinal injection? The reason is contained in a simple statement made by one of our fellows.
A few weeks ago, we had a patient who needed to be checked for a postprocedure infection. I couldn’t see the patient, so I had one of our two fellows check him out. While all of the data looked like the patient didn’t have an infection, what the fellow told me verbally was important. He said that the patient “didn’t look toxic.” What the fellow meant was that after training in a large university medical center where he saw many patients who were infected and toxic, or “sick,” and many who were not, he was using that experience filtered through the large neural network in his head to rule out a pattern of patient characteristics that he had associated with patients who were sick, or toxic. These may be the paleness of the skin, a glassy look in their eyes, how they interact, and so on. Every MD or DO who trained in a large university medical center knows what that fellow meant. The issue with naturopaths, chiropractors, and acupuncturists is that they don’t train in these settings. So when they learn how to perform procedures that may injure patients and make them “toxic,” they have no way of knowing, despite many weekend courses, how a sick patient presents. Why? Most of their training is on well patients with chronic problems, like pain or irritable bowel disease or allergies, not on ill patients undergoing surgery in the hospital.
Also naturopaths don’t get exposed to surgical disciplines. They aren’t in the operating room assisting and then caring for that sick patient on a hospital ward. They also don’t get exposed to things like spinal injections in their training. This lack of exposure also means that their training is not focused on what can go wrong when a needle is placed a few millimeters too deep in the spine.
When I was a kid, my mom used to bake a “Raisin Cookie Sheet” (basically a raisin pie baked in a large cookie sheet). We kids used to play a game of “Hold That Line.” Each successive child would slice a line of pie off the end so that my mom wouldn’t notice, but with seven kids, it wasn’t long before my mom would find out! Naturopaths are also now involved in a massive and unsafe game of “Hold That Line.”
This slow move from minor surgery to significant procedures is the game I see naturopaths playing. They don’t have the base training to perform surgical or advanced guided-injection procedures safely as nowhere buried in their hours of training is 500 hours spent on a hospital ward caring for patients who are circling the drain after surgery. Despite that, they have convinced state legislatures that they should be able to perform minor surgical procedures, like putting in stitches or taking out a cyst in the skin. These procedures then enable naturopaths to find their way into courses where invasive regenerative-medicine procedures are taught. Add in the fact that most of these courses are now taught by for-profit companies rather than nonprofit professional associations, which makes getting in the door that much easier. They advance from knees to spinal injections, but unlike the MDs and DOs in the course, they don’t have the basic training to perform these procedures safely and recognize complications when they happen.
How far has this trend advanced? We have a naturopath in Utah who is performing advanced spinal injections normally only taught to MDs in interventional pain fellowships. How did that happen? A game of “Hold That Line.” A simple trigger-point-injection course led to a knee-injection course and then a spinal-injection course and so on. Each successive course completion was used as proof that he or she was qualified for the next course.
We also now have at least 100 naturopaths nationwide who are performing surgical-style stem cell harvest and reinjection procedures. We have a similar number performing spinal prolotherapy, which is leading to the complications discussed. How long will it be before these naturopaths are performing really high-risk procedures?
The upshot? While I love my family naturopath, he was never trained to be able to perform surgery or an image-guided stem cell injection. Nor did state legislatures ever contemplate this game of “Hold That Line” would happen. So word to the wise, be cautious out there! While your naturopath may be a genius of natural remedies, you couldn’t pay me enough to have one stick a 3.5-inch needle in my neck a few millimeters away from my spinal cord!
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…