Friday, May 21, 2010

How to Identify and Avoid Phony Practitioners

How to Identify and Avoid Phony Practitioners

Seems like everyone who wants to can be a doctor these days, no schooling required. A dictionary definition of a doctoral degree is:
• any of several academic degrees of the highest rank, as the Ph.D. or Ed.D., awarded by universities and some colleges for completing advanced work in graduate school or a professional school
• an honorary degree conferring the title of doctor upon the recipient
• a degree awarded to a graduate of a school of medicine, dentistry, or veterinary science

It’s that second definition that is most troublesome, because it means that anyone can open up a virtual school and award doctoral degrees for whatever level of work – or dollars- they think sufficient.

The field of naturopathic medicine is shot through with such fraud. Only 16 states license naturopathic doctors. The licensing process requires graduation from a 4 year naturopathic school with virtually the same curriculum as that of a medical school, with natural treatments substituted for drugs and surgery.

These institutions have been accredited or are in candidate status for accreditation by one of the regional accrediting agencies approved by the US Department of Education. In addition, all of the naturopathic medicine programs of the member schools have been accredited (or are candidates for accreditation) by the Council on Naturopathic Medical Education (CNME).

On the other hand, the naturopathic schools that offer long distance education say that their courses are approved by the American Naturopathic Certification Board (ANCB). These graduates are not eligible for professional licenses. Strangely, the ANCB's website states "Due to ANCB's stringent application and certification requirements, ANCB is the certification organization preferred and recommended by the leading schools of Traditional Naturopathy, including Clayton College of Natural Health and Trinity College of Natural Health" [both are online diploma mills]. Does this seem a little incestuous?

Now naturopathy has come to veterinary medicine. One online diploma mill requires a “recognized Master's degree in a natural health field” to enter ‘doctoral’ programs offered there, but no definition of what this means. The accreditation for this school is through the American Association of Drugless Practitioners (Texas). That’s all.

We even need to worry about people making up certifications on their own. I once taught a course online on herbal medicine that was open to veterinarians and veterinary technicians. A technician, after finishing the course, granted herself a “Dip.Vet.Bot.Med” on her website, where she was offering animal health consultations. This was new to me as the instructor of the course. Presto – certified in herbal medicine after a 4 week introductory course!

So how do we judge the quality of the educational experience for practitioners of animal medicine? Let’s compare the curriculum and experience of the diploma mill to that of a veterinarian who is familiar with naturopathic principles:

Veterinary education (in the U.S.):
• Requires an undergraduate (college) degree from a university or college accredited by the US Department of Education, with a concentration on chemistry, biology and physics.
• 3 years of full time, in residence schooling that includes about 6 hours daily of didactic lectures, labs and contact with instructors who hold advanced degrees or certifications in their fields
• Required textbooks are comprehensive specialized reviews of medical science
• 1 year of full time clinical experience under direct supervision of faculty who are specialists in their fields
• Regular competency exams culminating in national and state board examinations that must be passed in order to obtain a license to practice.
• Further education on herbal medicine, acupuncture, homeopathy and other natural modalities requires well over 100 hours of study for certification each. A recent survey of 300 veterinarians who practice natural or integrative medicine revealed that 61% of veterinarians with at least 6 years of integrative practice experience have accumulated at least 250 classroom hours in integrative medicine. Of these practitioners, more than 30% have taken more than 500 hours of class room training.

Diploma mill doctoral degree:
• 200-300 hours (claimed) of self study
• Faculty - just a few of the school’s own graduates - available by phone or email
• Required textbooks are simple compilations for pet owners, typically available at your local book store
• Final exam is 3-5 questions, open book

Graduates holding a “VND” or “Doctor of Veterinary Naturopathy” degree have been taught that it is illegal for them to diagnose or prescribe in order to treat animal disease, so they position themselves as educators. Of course, the fact that they suggest treatment recommendations after learning symptoms, and the fact that they often sell just the natural remedies needed certainly could not be viewed as prescriptions (please know that I have on my most ironic smile right now). In addition, they make these recommendations without seeing the animal, which could vitally change the prescriber’s overall assessment. Yes, some veterinarians also do this, but most have medical records or direct communications from a veterinarian who has seen the animal, which solves that problem.

Any veterinarian understands the pet owner’s desire for second opinions and to have a team behind their pet’s medical care. But you can do better by your pet if you stock that team with professionals who have received comprehensive and well rounded veterinary and natural medicine education. Look for the initials below:

Veterinary degree: VMD, DVM, BVSc, MVB, VetMB or BVetMed, BVM&S or BVMS, Dr.Med.Vet
Natural medicine certifications (post graduate training offered only to veterinarians):
Acupuncture: CVA, FAAVA
Herbal Medicine: CVCH (Chinese herbal medicine), CVHM (Western herbal medicine)
Homeopathy: CVH, VetMFHom, CertIAVH
Chiropractic: cAVCA, IVCA, CVSMT
Physical therapy/rehabilitation: CCRT, CCRP
Chinese massage (tui na): CVTP

Nonveterinarians holding the “VND degree” and those who follow them may well wonder why we can’t all just get along. The argument would be that they offer only information that is complementary to that of veterinarians, and that they are only educating pet owners on how to better care for their pets. The situation feels to me much like medical practice in the US in the early 1900s. There were many private medical schools and many different educational experiences, and people had many different types of practitioners to choose from.

In the course of determining which type of practice and schools should be the recipient of grant money, the Rockefeller Foundation hired Abraham Flexner to thoroughly investigate all medical schools in the country for the first time. The report is eye-opening. Most of the naturopathic and homeopathic schools presented their students with very poor experiences – most did not require a college degree; none of the faculty was full time, and few of the students had access to actual patients in a mentoring atmosphere. Some of the schools were described as filthy, with libraries of only a few old books. By contrast, the schools that offered the best education required college degrees and 4 years of didactic and bedside education. If your mother developed a serious medical condition in the 1920’s, which type of graduate would you have wanted to see her?

These are not complementary veterinary professions. And I can already hear the defense - 'those veterinarians are just worried about competition'. No we're not. We're worried about what happens to sick pets whose owners don't know the difference between in-depth veterinary and natural medicine knowledge and a fake. If they know the difference and choose a "VND", the pet still suffers, but the owner is making an informed choice. The trouble is - most owners don't. So if that internet expert with a Dr. in front of her name offers consultations and sells supplements, it's a good idea to look for those letters, then make your decision.