You don't often hear about people transitioning from alternative healing to science-based medicine or vice versa. That's what makes someone like Dr. Oz — a highly credentialed surgeon who also believes in "energy healing" — so interesting. It's also why, when I stumbled across Britt Hermes's blog — Confessions of a Naturopathic Doctor — I was immediately hooked.
Hermes studied naturopathy, a type of alternative medicine focused on "natural" treatments like herbs and homeopathy, at Bastyr University in Kenmore, Washington. She then practiced for three years in Washington and Arizona — all while becoming increasingly disillusioned with her chosen profession.
"Naturopathic medicine is not what I was led to believe," she wrote on her blog. "I discovered that the profession functions as a system of indoctrination based on discredited ideas about health and medicine, full of anti-science rhetoric with many ineffective and dangerous practices."
Last year, Hermes left naturopathy behind and enrolled in a Master of Science program in Germany. On her blog, she's been myth-busting alternative medicine, and writing about everything from the gaps in regulation to what it's like to find cancer in a patient as a young ND.
Her crusade is not only personal; it's about protecting public health. In a number of states, NDs can prescribe pharmaceuticals, do minor surgery, and essentially act as primary care physicians.* The problem is that they have only a fraction of the clinical training that medical doctors do, and their education, as Hermes and others have pointed out, is peppered with dangerously pseudoscientific health claims. This is her story.
Julia Belluz: Why did you go into naturopathy?
Britt Hermes: I started with really high aspirations and a really idealistic point of view. During my education at Bastyr, some of that was upheld. I felt quite motivated, like I was choosing the right path. I had a lot of perception bias and self-fulfilling prophecies. I saw myself getting better, friends having healing experiences, that now in hindsight I realize was due to other things — self-limiting conditions, evidence-based medicine sprinkled in with the naturopathic medicine we were doing.
I graduated from Bastyr and wanted to do a residency. They are so rare, and I thought a residency would give me a leg up. So I worked in an outpatient clinic, and it was rewarding. I administered vaccines, dispensed antibiotics, tried to stick to the standard of care as much as possible by referring evidence-based sources like UpToDate.
JB: Wait a second ... You were a naturopathic doctor, and you were essentially doing the work of a primary care physician?
BH: In the US, there are 20 states and territories that allow licensed naturopaths to practice some form of medicine. Within those, the jurisdiction around naturopathy varies widely — but the states that allow naturopaths to do the most include Washington, Arizona, Oregon, Vermont, California, New Hampshire, Connecticut, Montana, and Utah. [NDs can effectively practice as primary care providers in Vermont, Oregon, and Washington — see note at bottom.]
I worked in Washington and Arizona, and I saw everyone from newborns to senior citizens. I did everything from newborn exams to jaundice checks to breastfeeding checks with moms, helping moms get pregnant, seeing kids with chickenpox, flus, colds, coughs, ear infections, broken bones. It was definitely primary care.
But I also had patients who saw me just for ND things — a child with autism who had an MD, but the mom brought him to me for some of the nutritional concerns. I saw a lot of kids for food allergy testing. I saw some chronically ill patients.
JB: Did you feel qualified or prepared for this kind of work?
BH: I felt very nervous and talked about that with my mentors. They justified it that all new doctors feel nervous. I still feel I was a good doctor in some ways. It’s absurd, because I never trained as a doctor. But I had really meaningful connections with patients, I really cared, I wanted to help that person get better.
JB: When did things start to go sour for you?
BH: I moved to Arizona, and I wanted to work with an MD in integrative medicine. I landed in a private ND practice. Because insurance reimbursement was nonexistent in Arizona, my patient base changed.
I went from seeing families, doing well-child visits, to doing more of the "naturopathic-y" stuff. I guided people through detoxes, saw patients with multiple chemical sensitivities, patients with chronic Lyme — more of the woo woo diagnoses that mainstream medicine [has rejected].
It was harder to make money because patients had to pay for the entire visit out of pocket. The fee to see me was expensive — $185 for a new patient visit, and if I recommended any supplemental treatment or care, it was more.
What was off-putting was watching the other naturopaths in my office practice, to be frank. One saw cancer patients. It was off-putting to watch the naturopathic care of cancer patients, to see the alternative and non-science-based therapies recommended for some very sick patients. The cancer patients — many got IV treatments with high-dose vitamin C and different herbs.
I was under the impression, when I was going through school, that these treatments were science-based and evidence-based and helpful for cancer patients. But one of the things I came to find out as I was doing more research was that these alternative therapies are not proven, and in some cases are harmful to patients. One study stands out: Researchers found that cancer patients who chose to use alternative therapies died sooner and had a lower quality of life.
JB: Were you also caring for cancer patients?
BH: I remember one patient who was very anxious and concerned about her health. When she came in to see me, she gave me a long description about all the different therapies she had been trying: acupuncture, cod liver oil, different herbs, yoga, and meditation. And when I did a physical exam on her, it was very clear to me she was very sick. So sick that my medical recommendation was to refer her to a gastroenterologist as soon as possible and let a medical doctor take over her care.
But the patient didn’t want to see an MD. She was a patient who had specifically chosen an ND because she didn’t like mainstream medicine.
This patient stopped care with me over the course of a week and started care with another naturopathic doctor in the office who agreed to see her even though it was against my recommendation. I remember saying, "She’s very sick. She has a giant liver, and other concerning signs." Even after I had this conversation with the naturopathic doctor, the ND decided to see the sick patient anyway. She recommended some nutritional therapies.
I later found out that this patient actually had liver cancer. The signs were so ominous. She had the biggest liver I could ever imagine feeling. She had weight loss. She was tired. She looked sick. That was one of many sorts of failures that I saw in the office.
It just became clear I was part of a profession that shouldn’t be operating as MDs. They were missing obvious signs, taking on terminally ill cancer patients with the promise of a longer life, better quality of life. It all felt super unethical.
JB: After this horrifying experience, what do you think about the fact that some NDs essentially act as doctors?
BH: Not all NDs are that bad. There’s no doubt — we’re just not qualified to practice medicine. We don’t have nearly enough patient contact. We don’t have nearly enough clinical training. The phrase that always comes up is that NDs see the worried well. That’s what they’d say at Bastyr. The idea is that we’re not actually seeing sick patients. This sets us up to miss things like cancer.
I think it’s a really sad situation for everybody. It’s sad for the naturopaths. We’re paying hundreds of thousands of dollars to receive an ND education. We’re told our education is accredited, which provides this facade that means it’s accepted by US Department of Education. But it doesn’t mean that. Bastyr uses phrases like "the same as medical training, on par with MDs."
They're duping patients into fake medical treatment for cancer and many chronic illnesses with dubious therapies and IV treatments or some of these outrageous detox protocols for people who have never had toxic exposure to anything. The danger it poses to patients is they come into contact with ill-equipped and incompetent naturopaths who miss dangerous and important diagnoses.
The other frustration is the seeming lack of oversight by the state board that manages the licensed naturopaths in their respective states.
JB: Besides fighting pseudoscience on your blog, what else are you doing since you retired from the profession?
BH: I’m in a Master of Science program in northern Germany. It’s in biomedical research. I’m focused on the application of molecular biology in a clinical setting. The classes here are much harder.
*Note: I checked with the American Association of Naturopathic Physicians about naturopaths' scopes of practice. This is what their director of government and public affairs told me:
- NDs are licensed in 20 states and territories. The widest scopes of practice are in Vermont, Oregon, Washington, California, Arizona, New Hampshire, Connecticut, Montana, and Utah.
- NDs effectively practice as primary care providers in Vermont, Oregon, and Washington.
- NDs can perform "minor surgery" or "minor office procedures" in Arizona, Colorado, Hawaii, Maine, Minnesota, Montana, Oregon, Utah, and Washington. Variations on this language exist for NDs in Alaska, California, DC, Kansas, and New Hampshire.
- NDs have prescriptive rights in about half the jurisdictions in which they’re licensed, namely Arizona, California (with MD/DO oversight), DC, Hawaii, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington. The broadest formularies are to be found in Arizona, California, Hawaii, New Hampshire, Oregon, Utah, and Washington. Vermont did away with its formulary: NDs there can prescribe whatever medications are consistent with their education and training.