Thursday, November 26, 2009

With Great Power... are you prepared for the implications?

It's fair to say that we've seen our first official shit-storm over at Skeptic North.  I am speaking of the same issue I was writing about in my last post.
Ontario is about to follow BCs lead and give prescription rights to Naturopaths.
The idea of naturopaths prescribing is wrong on so many levels that have been covered by many other people: It flies in the face of what they claim to be their core practice; they are not sufficiently trained; the spectrum of their practice includes as much hokum as reality (I am being generous on that front.); and the arguments they are leveraging to get those rights generally speaking don't hold up.

But let's just cast that all aside, just for a minute shall we?

What if we were to simply give in?  What if we threw our hands up and said "yeah sure, you can have prescriptive rights... but this one is on you when it goes bad."

Before I go further, let me be clear:  What I am proposing here would be a lousy tactic for those of us in favour of reason to submit to employing.  It is lazy, but it may be all we have left when the dust settles.  The only version of this that results in good things comes from wearing so many pairs of rose coloured glasses as to block out the light of reason.  The reality is that for this tactic to have a positive social effect, someone - and really that means "some-many" will get hurt, probably die, first.

But lets look down that road, shall we?

Some NDs are crying out that this is a necessary step towards better regulation of Naturopathy (which is, if you ask me, putting the cart before the horse, but let's take the argument at face value).

Okay - great.  So how is this going to work then?  Are Naturopaths going to have an oversight committee that enforces standards?  That de-licenses all those sham-NDs who practice the treatments that fall into the 'bogus' territory of the ND's tool-kit?  That penalizes those who are found to be using herbal remedies that have not been rigorously tested and manufactured with a strict care for consistency?
Is there going to be a tracking system put in place so that when a patient goes to an ND first, and then when the treatment they recieve fails to work and they go to Emergency, un-healed, possibly hurt, maybe even die in the hospital as a result of Naturopathic negligence that the culpability flow-chart includes the Naturopath?  Make no mistake - currently a lot of people who meet their button-maker as a result of failures in Naturopathy end up doing so on the statistical report-card of the medical establishment.
Will all naturopathic remedies need to be prescribed so that people who oversee drug conflicts (pharmacists) are kept in the loop?

It may be a bit cynically Polly-Anna-ish of me, but I think in the long-game this may actually be regulated in a defacto manner by the inurance companies.  They aren't dummies.  Their particular gambling game is all about weighing the odds and pricing their services at a level that (god forbid) makes them money.  In order to do that competitively they need to factor reality into the equation.  Treating placebos as medicine will only put them out of business.  With an inevitably higher incident of malpractice, the insurers will have to charge NDs higher premiums.  This cost will get passed on to the user.  In the end, who do you want to give your money to?  The doctor whose practices work and is (relatively) cheap?  Or the quack who has to financially soak you, just to stay in business?

Either way, NDs will eventually be pushed into a position of better practices.  Eventually we may be able to call them doctors with out the qualifier.  It happened to osteopaths, it seems to maybe happening to Chiropractors.  (If so it is happening at a glacial pace.)  If you want legitimacy, you gotta wear the yoke that comes with it!

This is a slow road to follow, and it will be marked by tragedy along the way.  It is not the best solution.  The world would be a far better place if we could bring the Grendel down at the start of it's rampage.

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