Fake Doctors and Now Fake Medical Care

If 6 + years is required to train physicians to acquire the knowledge and judgment to prescribe these dangerous and sometimes lethal drugs why does anybody, especially the Legislators, think it can be done in two years.

(MOLALLA, Ore.) - I was aghast to read in The Oregonian, May 5, 2009, that the Oregon Legislature was planning to allow psychologists to prescribe the most dangerous and lethal pharmaceuticals to “their” patients.

We have already seen what has happened in the VA hospitals where psychologists and even social workers are prescribing these extremely dangerous medicines. If you haven’t read or heard about it, these VA patients have a very high rate of suicides, homicides, other illegal drug use and homelessness. All of these can be related to “cookie cutter”, “cookbook” prescribing by the untrained.

Medicine should be prescribed by those trained to do it and it includes Medical Doctors (MD’s), Doctors of Osteopathy (DO’s), Nurse Practitioners (NP’s), and Physician Assistants (PA’s) to a lesser extent under direction of an MD or DO. There is a reason for this as I will try to explain:

To even get into Medical School or Nursing School with accelerated nursing programs, the student must have a heavy college background in biological and physical science. Only medical and nursing students have this background – IT’S REQUIRED.

Once they get into the school they have advanced biochemistry, physiology, gross and micro anatomy, pathology, neurology, bacteriology, and finally pharmacology, the bridge to medicinal therapy.

All this takes 4 years and they are not trained and ready yet. During their last/4th year they have clerkships where they follow staff doctors in hospitals or clinics to see and learn how to medically treat patients.

Their training isn’t over yet. When they start their internships they are heavily monitored by senior residents or staff doctors. For many the once standard one year internship isn’t considered enough and some training residencies can last 4 or more years and this is a constant learning experience before they are turned loose on the public. Even then they are required Continuing Medical Education Classes (CMES).

Many patients will agree even all this isn’t enough. Have you ever heard of medical malpractice?

Now to get back to psychologists. Oregon House Bill 2702 says that the prescription privileges would be limited to psychologists who meet strict training and educational guidelines. I wonder if this is supposed to include a medical education. It sure doesn’t look like it. If these psychologists had the necessary biologic and scientific training they could get into medical school or a nurse practitioner program.

Another part of the Oregonian story was an effort to grant general prescription privileges to Naturopathic Doctors (ND’s). They already have limited prescription privileges for natural -- NOT synthetic drugs.

I taught a voluntary, non-required pharmacology course at the Naturopathic College. I even told the students exactly what the final exam would be my first lecture. When final exam day came around almost all students dropped the course. Looking over their academic curriculum, I couldn’t help but notice that the medical school courses which I outlined above were presented in a very elementary level and most of the curriculum was directed at joint and muscle manipulation much like chiropractic which has no medicinal courses.

The preparatory course for psychopharmacology for psychologists is 2 years plus 800 hours (20 weeks) of supervised dispensing. If medical schools require at least 6 years of training to achieve medicinal prescription competence how does anybody think this could be achieved in two years.

I note that the Oregon Medical Association and the Oregon Psychiatric Association are against all this. This is rightfully so. If 6 plus years is required to train physicians to acquire the knowledge and judgment to prescribe these dangerous and sometimes lethal drugs why does anybody, especially the Legislators, think it can be done in two years.

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Tony October 8, 2010 5:24 pm (Pacific time)

I take issue with Dean Bettenburg's comments. It would be very exhausting to address every issue I have with naturopathic medicine, so I will simply comment on your defense of naturopathic pharmacological training. First, 72 hours is no magic number for ensuring the public safety. This is simply an accounting of your contact hours. Believe me, as a Pharmacist and now medical student, I can assure you that the content and depth of the training are key. Anyone can memorize facts about a drug. Can your students apply (clinical pharmacology) what they learn to real patients under many, many patient and disease specific circumstances like we are taught in medical school? It is also a fallacy to assume that your students are somehow more prepared to prescribe because they are taught pharmacology by physicians and the “pharmacological doctors” you speak of, whom I assume are PH.D.’s. It is the content of the course that matters. Don’t get me wrong, you must have qualified experts to be sure, but their credentials are irrelevant if they are only meant to scratch the surface of the subject matter. In other words, I'm more interested in the goals, objectives, and outcomes of your training and not how many hours of lecture your students attend. In that same vein, it is my understanding that no residency of any kind is required to become a licensed naturopath. And, if I’m correct, why not? Training on the hospital wards and in the clinics is where the proverbial rubber meets the road. I can 100% believe that you are very misguided if you think that a competent prescriber can learn all that they need to know from a classroom, book and perhaps a few clinical hours while he/she is a student without any real (licensed) responsibility for a patient. This is exactly why medical doctors are required to complete an internship and residency. I assure you that patients and diseases do not always behave the way they do in a book. There is absolutely no better way to become a proficient and safe practitioner at the level your profession claims to be (i.e. primary healthcare provider) without this sort of background. So, I guess the real question is: Does your profession espouse that medical doctors receive a lot of unnecessary training in order to prescribe? We must if you assert that your profession receives enough.

Thinh Mai MD June 19, 2010 11:31 pm (Pacific time)

I believe that there needs to be a solution to this issue. On the one hand, we need to have more psychiatrists and trained practitioners who can manage patients psychiatrist illnesses. However, approximately 30-40% of those with psychiatric signs and symptoms are caused by medical illnesses. Several examples that comes to mind are A. Fib, gastric ulcerations, IBD, etc., that can be mis-diagnosed as panic disorders or GAD. If these patients come to a psychologist first, who they be able to do an appropriate DD? Another concern is >50% of psychiatric patients have comorbid medical illnesses requiring multiple medications. Would psychologists understands that DMII or HTN poor control/medications affect moods more than psychotropics? A great solution is to train undergraduate students interested in psychology and medicine from the start. Having a combination program of 6-8 years of training followed by 2-3 years clinical supervision. This way we will get a true psychiatric clinician while saving time and money. Remembered that the cost on the DoD New Mexico Clinical Psychologists was more expensive to train than training psychiatrists. In addition, these psychologist had extensive experiences clinical experiences to understands the art of medicine. In closing, there needs to be a solution to provide adequate manage for mental illnesses. Unfortunately, this bill might do more harm than good.

Lindsey March 23, 2010 9:40 am (Pacific time)

Dr. Leveque- Do you really have any idea what you are talking about? Prescribing psycholgists have extensive training both in the classroom and the field. Additionally, their training in grad school takes YEARS longer than that required of medical students. It is even harder to get into a clinical psychology PhD program than it is to get into medical school! If anything, psychologists are BETTER able to determine the use of psychotropic medication due to their much more significant training in neuropsychology and clinical issues. FYI: Vets have been committing suicide for years, and it's not due to the misprescribing of medication.

Natalie MD June 15, 2009 11:32 pm (Pacific time)

If ND are qualify for natural medicine only why they need to prescribe pharmaceutical drugs. Is naturopathy is becoming quakery by claiming every system of medicine as part of there system. Even the modern homeopathic system is not part of naturopathy. Only botanicles can be consider as part of naturopathy. Why don't they try to work hard and prove botanicles more effecftive. Why they want to to work on other peoples working and taking all good pills in the name of socalled naturopathy

Tim Shea June 7, 2009 9:09 am (Pacific time)

You conveniently ignored my request for a peer-reviewed citation about, "social workers are prescribing these extremely dangerous medicines.", and instead provided self-published op-ed pieces. It was my understanding that NO social worker has the ability to prescribe in any setting. Also, can you please provide some peer-reviewed research connecting the higher suicide rates, drug abuse, etc. with the [“cookie cutter”, “cookbook” prescribing by the untrained"]. Please be sure to differentiate between the psychiatrist prescribers and the psychologists prescribing. Based on the links you provided it seems that your arguments are anecdotal, which any scientist/researcher knows is not sufficient to stand as "fact".

Editor: Well how about these:

VA Inadvertently Confirms that a Thousand Vets a Month are Attempting SuicideTim King Salem-News.com

Army Suicides: The Invisible Elephant in the Pentagon - Dr. Phillip Leveque Salem-News.com

Anaka & Burr Call for Prompt Top Level DOD/VA Meeting on Military Suicides - Salem-News.com

PTSD: VA Lies, Damn Lies And Statistics - Dr. Phil Leveque Salem-News.com

Veteran Suicide Epidemic: The Shame of America - Dr. Phil Leveque Salem-News.com

I hope you enjoy your federal job with the VA.

Tim Shea May 27, 2009 5:23 pm (Pacific time)

Can Dr. Leveque please provide a citation for the following statement: "We have already seen what has happened in the VA hospitals where psychologists and even social workers are prescribing these extremely dangerous medicines. If you haven’t read or heard about it, these VA patients have a very high rate of suicides, homicides, other illegal drug use and homelessness. All of these can be related to “cookie cutter”, “cookbook” prescribing by the untrained." I am not sure where he practices, but I have yet to see a social worker prescribe medication, nor have I heard of these "incidents" in the VA system.

Articles should uses facts and data to support statements, not straw man arguments and scare tactics.

While on the topic, what about the tens of thousands of prescriptions that have been written in NM and LA without incident

Editor: You sure you want to open this up Tim? Before I go on, I doubt you will meet more than one or two people in your life who know more about medicine and pharmacology and forensic toxicology than Dr. Phil Leveque. Anyone can easily learn that he has few equals after a lifetime of medicine. More importantly, before Phil ever treated a patient or trained a doctor, he fought as a member of Gen. Patton's Army in WWII and has a very personal understanding of combat-related PTSD.

You asked for citations: glad to provide this for all of our readers:

Fake Doctors and Now Fake Medical Care

Marijuana, Battle Veterans and the VA

PTSD and Psychosis Among Army Psychiatrists

This one is written by a Marine Corps Iraq vet who was addicted to DoD and VA drugs:

Marine Combat Vet Discusses Iraq, PTSD and Medical Marijuana

There are many more. Certainly you aren't surprised that agencies are cutting corners due to the economy. Veterans are always the first to serve their nation and the first to be treated like cattle in a VA medical center.

We have several articles written by Dr. Leveque and myself that detail the various lies that top-level VA officials have been caught in, relating to PTSD and veteran suicide. He believes the bar is simply not high enough and that people who prescribe drugs should have the proper training, which in his opinion is not something that automatically comes in the form of a four-year education.

Fraulien May 21, 2009 10:40 pm (Pacific time)

Psychologists have 5-6 years of graduate work They would have to then earn a Master's Degree in Psychotropic Medication and then have 800 hours of supervision in seeing patients. I think that is easily equal to the training that other medical providers have.

Rita Bettenburg, ND May 11, 2009 7:02 pm (Pacific time)

As Dean of the Naturopathic Medical Program at National College of Natural Medicine in Portland (where I graduated in 1989) and a member of the Council for Naturopathic Medical Education (the federal accrediting body for the naturopathic colleges), I must take issue with Dr. Leveque’s assertions in his article “Fake Doctors and Now Fake Medical Care” (May 9). First, while Dr. Leveque claims to have taught at a “Naturopathic College,” there is no record that he taught at NCNM, at least not in my 24 years of experience with the school’s naturopathic program.

NCNM is the oldest Naturopathic Doctoral program in North America. It requires 4,620 hours of education, including 1,548 hours of direct clinical exposure. This is comparable to educational requirements for other types of medical colleges. It is a four-year, in-residence program. The programs in naturopathic medical schools are subject to federal Department of Education oversight.

I completely agree with Dr. Leveque’s comments that “Medicine should be prescribed by those trained to do it.” For at least 20 years, NCNM students have been required to take a rigorous course load of 72 hours of pharmacology, which requires them to learn about all classes of pharmaceutical agents, regardless of their ability to prescribe them under Oregon law.

The current program includes the principles of pharmacodynamics, side effects, and therapeutic uses of legend, or prescription, drugs. Our courses are taught by medical doctors and pharmacological doctors from OHSU and other respected medical teaching institutions. This course load compares favorably with other professions that have primary care prescribing rights.

Since 1929, the Oregon Licensing Board has allowed naturopathic physicians to prescribe natural medicines. As a side note, the Oregon Board of Natural Examiners is the only medical licensing board in the state that requires that naturopathic physicians receive ongoing annual continuing education in pharmacology.

One of the issues arising in pharmacology as natural medicine has become an ascendant form of health care with the general American public is that pharmacognosists (those who study the physical, chemical, biochemical and biological properties of drugs, drug substances or potential drugs or drug substances of natural origin) face increasing difficulty differentiating between the chemical structures and differences among natural, synthetic and semi-synthetic drugs.

Naturopathic physicians in Oregon prescribe from all drug classes within their formulary, which comprises about 70 percent of all primary care drugs. SB327, which the legislature is now reviewing for passage, is intended to clarify prescribing rights based on the best drug for a given condition, rather than prescribing rights based on an 80-year-old definition of drug chemical structure that no longer serves our patients.

A rational and clear exclusionary formulary will benefit Oregonians, at a time when Oregon is facing a critical shortage of primary care providers, allowing more economical and patient-centered health care delivery.

Editor: I called Dr. Leveque about this: Dr. Hoffman -Smith hired Dr. Leveque to teach a course on pharmacology in 1987. Dr. Leveque was offered $35 per lecture and since the college had a printing press and book bindery, he chose to take his compensation in books.

Tim May 10, 2009 6:37 am (Pacific time)

Unfortunately Dr. Leveque has over-estimated the quality of the proposed training for psychologists who wish to prescribe under this bill. The APA model calls for 400 contact hours of education, which can be (and is)taken through online courses! These would be psychologists who are starting virtually from scratch, as they only need one biologically related course for their degree. Imagine being prescribed drugs by someone whose trifling medical education was on a computer and has never been in a hospital or medical clinic.

Bill Robiner, Ph.D. May 10, 2009 4:53 am (Pacific time)

The problem with psychologist prescribing is that they lack the foundational scientific training in the biological sciences that physicians, nurse practitioners, and physicians assistants have obtained. Prescribing is controversial among psychologists because of the shortcuts in the proposed training. The training programs themselves do not meet the accreditation criteria of the American Psychological Association for doctoral or postdoctoral training. If the training matched that of other prescribing discipolines, it would be a different matter, but only 7% of psychologists have ever taken biology and chemistry at the undergraduate level.

Dave Mittman, PA May 8, 2009 11:07 am (Pacific time)

Has the good doctor heard that there are 200,000 PAs and nurse practitioners prescribing in all 50 states across America. We do it very well and have no problems with either efficacy or safety.
The psychologists will have to take it seriously and possibly have their work reviewed monthly but most of these medications can be safely used by them.

Editor: Dave, Dr. Leveque stated in the article that Nurse Practitioners and Physician's Assistants are among those he believes are qualified to prescribe medications under certain circumstances. My question to you is, do you quickly approve of those who aren't doctors prescribing medications to veterans in particular? I mean we are always treated sort of like cattle, so I wonder if you are more or less saying that this is OK because it is veterans that we are talking about?

julie May 7, 2009 7:51 pm (Pacific time)

As with any issue, this one has both positive and negative. I experienced a severe depression and began treatment with a psychologist. He can define the areas in my brain that have "re-activated" as I heal.

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