Oct 20, 2016

A woman who once practiced a form of alternative medicine is now taking a bold stance against it

Megan Thielking, STAT
October 21, 2016

A tomato plant is seen in among planter boxes on  the 700 square metre (7500 square feet) rooftop of the Bon Marche, where the store's employees grow some 60 kinds of fruits and vegetables such as strawberries, zucchinis, mint and other herbs in their urban garden with a view of the capital in Paris, France, August 26, 2016. REUTERS/Regis Duvignau
Thomson Reuters
Britt Hermes once considered herself a doctor. Now, she's an apostate.

Hermes spent three years practicing naturopathy, a broad-reaching form of alternative medicine that focuses on "natural" care, including herbal remedies,acupuncture, and the discredited practice of homeopathy. But unease about a colleague's ethics led her to look more closely at her profession - and what she found alarmed her.

So for the past two years, Hermes has been waging a scathing fight against naturopathy on social media, in science blogs, and on her own website, Naturopathic Diaries, which just won a "best blog of the year" award from a scientific skepticism magazine in the United Kingdom. She has not pulled punches.

Hermes has said naturopaths use a "cornucopia of pseudoscientific methods." She posts articles with the blunt headlines like "Naturopathic pediatrics is not safe," "Naturopaths need to back off autism," and "Naturopathic medicine has too much quackery." And she's circulating an online petition to stop states from recognizing naturopaths as primary care physicians. Her message: "Naturopaths are not doctors."

"I'm trying to contextualize and call out the false and exaggerated claims," she said. "They want to be able to do everything an MD wants to do - but they also want to practice essentially witchcraft."

Hermes's activism comes at a time when the roughly 4,400 licensed naturopaths in the US are organizing and pushing for more legitimacy.

In May, more than 100 aspiring and practicing naturopaths descended on Capitol Hill to rally support for a federal pilot program that would allow them to be reimbursed by Medicare for some patients. They're also lobbying for expanded authority to diagnose and treat patients in a handful of states, including Massachusetts and Michigan.

Those lobbying efforts are funded in part by vitamin companies that want to see the profession grow. Many naturopaths tout dietary supplements, herbal remedies, and vitamin infusions for healing.

The American Association of Naturopathic Physicians declined to comment. But some of Hermes's former colleagues have attacked her for what they see as a misleading attack on the profession.

Mainstream doctors say Hermes is a powerful voice in taking on alternative medicine for one clear reason - she knows it from the inside out.

"Naturopaths dislike me, but they loathe Britt because she's a traitor," said Dr. David Gorksi, the managing editor of Science-Based Medicine, who has also spoken out against the naturopathic industry.

"They really, really, really hate her."

From itchy skin to a $200,000 degree in naturopathy
Hermes, who's now 32, spent her high school days plagued by terrible psoriasis, a skin condition marked by itchy, red patches. She started taking cod liver oil and changed her diet to see if either would help, which she thought they did.

"I became sort of obsessed with the idea of being able to treat it without prescription medicines," she said.

That sparked a deep desire in Hermes: She wanted to hit an ideal state of health without needing to rely on conventional medicine. She went on to enroll at Bastyr University, an alternative medicine school based in Washington state. It's one of a half-dozen naturopathic and alternative medicine universities in the United States.

At Bastyr, Hermes took classes with names that would seem familiar to conventional medical students, like human anatomy and physiology. But she alsostudied botanical medicine, hydrotherapy, and homeopathy, a practice founded on the theory that extremely diluted concentrations of certain compounds can treat disease. Homeopathy has been widely debunked as pseudoscience.

Currently, 17 states and the District of Columbia have laws requiring naturopathic providers to be licensed or registered. They need a degree in naturopathic studies and a passing score on the NPLEX, or the Naturopathic Physicians licensing exam.

Naturopathic students can opt to perform a residency, but there aren't nearly enough spots for the number of students graduating each year, said Jane Guiltinan, the dean of the School of Naturopathic Medicine at Bastyr. So many go right into practice on their own. By contrast, young MDs fresh out of medical school generally spend at least three years in residency, where they work under the supervision of veteran physicians.

Hermes has railed against the Bastyr curriculum as wholly inadequate to train practicing clinicians. She says she never learned about the medical standard of care for most illnesses and had minimal experience working directly with ill patients.

"I know it sounds cynical, but naturopathic medical care is like picking treatments out of a magical hat," she wrote in a blog post on Naturopathic Diaries back in May of 2015.

Dean Guiltinan disputes her assessment. "The curriculum at Bastyr is quite rigorous," she said. "I have full confidence that our graduates can enter primary care."

A patient's struggle with infertility
Hermes had that confidence, too. At least at first.

She graduated from Bastyr in 2011 and completed a one-year residency in family medicine and pediatrics at an alternative medicine clinic. (She was licensed under her maiden name, Britt Deegan).

She saw herself as a primary care doctor for patients who didn't want to seek conventional medical care - and she had no hesitation treating them. She provided checkups for kids and consulted with sick cancer patients.

"I had become so comfortable with the speech and the rhetoric that I considered myself a doctor," she said. "It wasn't difficult to convince anyone I knew what I was doing."

One of her patients, Emilie Bishop, was suffering from endometriosis - a painful disorder in which tissues normally inside the uterus grow outside it. She'd been struggling to get pregnant for months when her obstetrician referred her to a naturopathic clinic. Bishop had tried all manner of traditional medical therapies, including surgery to address the endometriosis, but it hadn't helped. She figured she didn't have anything to lose.

"Naturopathy can sound crazy, but it was no less crazy than anyone else's approaches," said Bishop, now 32.

She found her way to Hermes, who started her on a handful of supplements and a vegan diet. Their first appointment turned into an hour-and-a-half long conversation.

"It was really refreshing to have someone who really listened to how the problems were affecting me and my body," Bishop said.

But there wasn't any difference in her pain, and Bishop still struggled to get pregnant. As the months went on, Bishop grew wary of the recommendations Hermes made. Bishop points to one email she received from Hermes laying out plans to get her ovulating normally again to boost her chances of getting pregnant.

"She started playing fertility doctor, and she wasn't listening to what I wanted or what I needed," Bishop said. "I felt like she was out of her depth."

Hermes now realizes that she was - but at the time, she said, she genuinely believed in what she'd been taught.

"I trusted the naturopaths more than the scientists," she said.

Bishop tried other naturopaths but felt that they blamed her when their treatments failed. "I heard, 'You didn't do it long enough, you didn't do it well enough, you need to try harder,'" she said.

In the end, she did become pregnant and had a son. He was still little when she stumbled over the Naturopathic Diaries blog. She pored over every post Hermes had written.

"It was just so freeing to me to hear that it was all crap," Bishop said. "It wasn't that I wasn't doing the treatment well enough or that I wasn't trying hard enough. It was that I was using treatments that weren't likely to help no matter what I did."

Bishop reached out to Hermes and asked if she could write a guest post on the blog; Hermes obliged.

"I bear no ill will toward her. I bear a lot of ill will toward the naturopathic profession," Bishop said.

Soon enough, so would Hermes.

A distressing discovery leads to a quick exit
She'd been practicing in Arizona for about two years when she said she discovered her supervisor had been importing a non-FDA approved drug called Ukrain from Austria to treat cancer patients. Hermes found out on a Friday in May of 2014.

On Monday, she quit.

Hermes reported her supervisor, Michael Uzick, to the state board governing naturopathy. She wasn't just upset by his decision to treat cancer patients with an unapproved, potentially risky drug, she said. She was upset by how he responded when she confronted him.

"He said he knew he was walking the ethical and legal line, but that most naturopaths do this," Hermes said.

She also spoke with a mentor in the field, who told her that she was making too big of a deal out of the situation. Hermes couldn't shake her anger at the casual responses from colleagues she'd once respected.

Uzick was reprimanded by the board that governs naturopathic doctors in Arizona. He did not respond to a request for comment for this story.

But when he talked to Hermes, "He accused me of wanting to take down the entire naturopathic profession," she said.

She took that as a challenge.

After she'd quit her job, Hermes found herself in a serious bind. She couldn't get a job in the medical field or teaching medical science in academia with a naturopathic degree. She had spent more than $200,000 and four years on an education she felt she could no longer use.

"I literally needed to start over. I was terrified," Hermes said. She packed up her bags and moved with her husband to Germany for his work. There, she decided to go back to school to study science - again. Hermes is now in a master's program at the University of Kiel, studying the mammalian microbiome.

After her second day of molecular biology class in the new program, Hermes went home and cried. She'd thought she had learned the basics at Bastyr, but now she realized the coursework hadn't been nearly as rigorous as she'd thought. She was surprised she had to work to understand the concepts. Her previous studies had been a breeze.

"I remember studying for my classes while sunbathing by the pool," she said.

That frustration and anger sparked Hermes to start her blog, Naturopathic Diaries. She spends about 30 hours a month on it and other forms of media.

Dr. David Palma, a radiation oncologist at the Ontario Institute for Cancer Research, said he uses Naturopathic Diaries as a resource when talking with patients who want to seek alternative care.

He doesn't have a problem with them reaching out to alternative practitioners to complement their traditional medical care. But he has seen catastrophic consequences when a patient rejects a traditional therapy with a high cure rate and instead pursues an "all-natural" treatment.

"For us, as doctors, it's heartbreaking. But it's absolutely within a patient's rights as a long as that patient is well-informed," Palma said.

That's where work like Naturopathic Diaries comes in, he said.

Under assault from former colleagues
There's been an onslaught of criticism - some of it vitriolic - since Hermes began blogging about naturopathy as a former insider. The comments on her site say it all.

"[You] became very bitter to the field of Naturopathic Medicine due to the fact that you were not a good doctor period … You need to pray to God and he will lead you to what you were called to do on this earth, but it clearly was not to be a Naturopathic Doctor," one commenter writes.

Another commenter called Hermes and her guest authors "witch-hunters."

And an especially determined critic has set up a website to pick apart Hermes's petition to stop naturopaths from getting licensed.

That site, and many supporters of naturopathy, point to a handful of randomized studies that suggest it can have some benefit.

A 2009 study published in PLOS One, for example, looked at 75 patients with moderate to severe anxiety. They were treated with either a standard psychotherapy intervention that included deep-breathing techniques or a naturopathic treatment that included dietary counseling, deep-breathing techniques, multivitamins, and an herbal medicine called ashwagandha.

Both groups saw significant improvements in anxiety - but the naturopathic patients also reported more improvement in ancillary quality of life measures. The study did not, however, single out the individual effects of each treatment component to figure out what, if anything, gave the naturopathy recipients that added boost.

Another study cited by naturopaths looked at 207 patients with cardiovascular disease. Some patients received care from just their family physician, while others received care from both their family doctors and naturopaths who provided health and nutrition counseling or dietary supplementation.

Those in the naturopathic group had a 3 percent reduction in cardiovascular disease risk after a decade. But the study's authors point out that they didn't receive naturopathic care alone, but naturopathy plus conventional care. It's also possible that the difference came from the extra time they spent in consultation with a clinician - and that they would have gotten similar benefit from appointments with any type of health care professional, not just naturopaths.

Both those trials, and others cited by naturopathy advocates, are also small - larger, more robust studies would be needed to prove that naturopathic care is safe and effective for treating certain conditions.

Gorski said the attacks on Hermes aren't just about her work in naturopathy. They're about her as a person, too.

"What I have come to appreciate, perhaps because I'm a middle-aged white guy, is just how much [online] abuse, sexual and misogynistic abuse … that women put up with," he said. "And of course she's perfect for that."

Hermes tries not to take those attacks to heart - but that doesn't mean she's not listening.

"I am open to these critiques and consider them carefully," she said. "But none have yet [presented] a compelling argument that I have mischaracterized naturopathic medicine."

So she's not backing down. Nor is she slowing down. For now, she's focused on building a career in molecular biology. She sees herself staying in the lab - and out of the exam room - and hopes to improve the lives of patients through her research.

Hermes said she doesn't have any desire to seek out naturopathic care anymore, but she recently got a lesson from her doctor about how stress might be affecting her health. Her iron levels were low and she needed to eat more meat, the doctor said.

"Here was this MD providing me what naturopaths would call naturopathic care. But the aspects that do work are not unique to naturopathy," Hermes said.

"I walked out of that appointment much happier than I should have been."


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