Naturopathy and “biomedical” treatments for autism

For the past several months I’ve been contrasting the advice from naturopaths against the scientific evidence, in a series I’ve been calling “naturopathy versus science”.  In past posts I’ve looked at the naturopathic perspectives on fake diseases, infertility, prenatal vitamins, vaccinations, allergies and even scientific facts themselves. From a blogging perspective, naturopathy is a fascinating subject to scrutinize, as there is seemingly no end of conditions for which naturopaths offer advice that is at odds with the scientific evidence. As a health professional,  I want to encourage the best use of health resources, and support patient autonomy and decision-making by providing credible, evidence-based information. Given repeated calls for naturopathy to be “integrated” with conventional medicine, I’ve spent a lot of time reading what naturopaths have to say about different medical conditions. What I’ve found is concerning. Naturopaths describe themselves a health professionals capable of providing primary care, just like medical doctors. And they’re increasingly seeking (and obtaining) physician-like privileges from governments.  Yet there is a lack of evidence to show that naturopathy offers anything distinctly useful or incrementally superior to science-based medicine.

Defining the scope of “naturopathic” treatment is difficult. Naturopaths offer an array of disparate health practices like homeopathy, acupuncture and herbalism that are only linked by the (now discarded) belief in vitalism – the idea we have a “life force”. From this philosophy can sometimes emerge reasonable health advice, but that has little to do with the science or the evidence. As long as it’s congruent with the naturopathic belief system, it’s acceptably “naturopathic”. One of the signs that naturopathy isn’t medicine is that it needs a prefix. Notice how there isn’t a “pharmacy medicine” or “nursing medicine” that’s distinct from science-based medicine. It’s just “medicine” – health professionals base their practices on scientific evidence and principles that reach across professions. Naturopathy doesn’t share the same evidence base as medicine, and in some cases, disagrees with its basic scientific principles. It needs to be qualified as distinct, and hence: “naturopathic medicine”. Notice how Rexall makes it easier to find the non-evidence-based products:

naturopathic and homeopathic

This week an advertisement was passed to me that promoted naturopathy at a Toronto public school: Continue reading

Naturopathy, Paternalism and Infertility Treatments

Pregnancy Test
This is another post in the naturopathy versus science series, where a naturopath’s advice is assessed against the scientific literature.

It’s Naturopathic Medicine Week in the United States, so it’s time for another look at the alternative medicine practice that blogger Orac likes to call the One Quackery to Rule them All. Naturopathy is an oddity among alternative medicine, because it’s a hodgepodge of other practices linked by an underlying belief in vitalism: the pre-scientific notion that living things have a “life force”. Vitalism disappeared from medicine when Wöhler synthesized urea in 1828, yet the belief in vitalism is a central tenet of naturopathic philosophy. Naturopaths liken themselves to be primary care providers akin to family physicians (general practitioners) but their practices are quite different: rather than make decisions based on scientific evidence, naturopaths pick and choose based on what they feel is congruent with their vitalistic philosophy, sometimes despite good scientific evidence that shows they are wrong. For example, homeopathy is an alternative medicine practice that is very popular with naturopaths. It is an elaborate placebo system where “remedies” contain no medicinal ingredients: they are literally sugar pills. There is no demonstrable medical effect from homeopathy, and so it isn’t part of science-based medicine. Yet homeopathy is a “core clinical science” for naturopaths, and the practice of homeopathy is part of their licensing exam.

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The truthiness of naturopathic “facts”

LaLaLaLa

This is another post in the naturopathy versus science series, where a naturopath’s advice is assessed against the scientific literature. It’s a cross post from Science-Based Medicine, where the original post has (at last count) 436 comments:

When you think medicine, your first thought may be “physician”. But the practice of medicine today is a collaboration, as few health professionals, even physicians, can deliver health care completely independently. As a pharmacist I’ve worked closely with physicians, nurses, and other health professionals my entire career. Collaboration starts early, and the setting is usually the teaching or academic hospital, which is always crawling with students, interns, and residents from all professions. Teamwork and trust are essential. In order for different professions to work effectively together, there has to be a common foundation. For medicine, that foundation is science. From basic science principles through a common understanding of fields like biochemistry and physiology, health professionals all work from the same basic understanding about how the body works and what the principles of medicine actually are. If I give a recommendation to a physician or a nurse, I’m basing that assessment on an evidence base that we both rely on. It’s not “pharmacist evidence” versus “physician evidence”, it’s “medical evidence”. This is reality-based healthcare. Continue reading

Which prenatal vitamin is best?

Pregnant2

Vitamin supplementation is unnecessary for the vast majority of people. You wouldn’t know this walking through a drug store, where you’ll usually find an entire aisle packed with supplements. Alternative health providers like naturopaths tend to be strong supporters of supplementation, but this advice seems to be based mainly on the belief that “vitamins are magic” rather than good science. The best research hasn’t established a strong evidence base for taking supplements. We definitely need vitamins in our diet to live. But that’s where we should be getting those vitamins – from our food, instead of from pills. If you eat a reasonable and balanced diet, and have no medical conditions that require special consideration, vitamin supplementation won’t offer meaningful health benefits. In the absence of any deficiency, vitamin supplements seem to be useless at best and harmful at worst. Continue reading

Naturopathy versus Science: The Vaccination Edition

Follow the link for the "response" to this cartoon

The re-emergence of vaccine-preventable disease should surprise no-one that’s been following the anti-vaccine movement.

Dealing with anti-vaccinationists is like a game of whack-a-mole, where the moles are the same old tropes that keep popping up, no matter how often they are refuted with facts. Vaccines are a remarkable success of modern medicine: They are health interventions that are both demonstrably effective and remarkably cost-effective. Vaccination has likely prevented more deaths in the past 50 years than any other health intervention. Smallpox was a ruthless killer that took 300 million lives, just in the 20th century alone. Today it’s gone – eliminated forever. And now there are now over two dozen diseases that are vaccine-preventable. They should be an easy sell, and to most people, they are. But the control of vaccine-preventable disease relies in part on herd immunity – sufficient immunization to stop the spread of infection (no vaccine offers 100% protection) and protect those that cannot be immunized. Even a modest number of unvaccinated individuals can lead to reemergence of disease. None of this matters to antivaccinationists, to whom vaccines are bad. Viewing anti-vaccine websites for only five to ten minutes can increase the perception of risk of vaccination, and decrease the perceived risk of omitting vaccines. It also lowers vaccination intentions. By changing perceptions of safety, the willingness to vaccinate decreases. Now imagine that someone you believe to be a health professional openly questioned the efficacy and safety of vaccines – would it reduce your willingness to vaccinate? The evidence says it does. And that’s why the modern practice of naturopathy or “naturopathic medicine” is so concerning. Naturopaths have opposed vaccinations since the invention of naturopathy – starting with smallpox: Continue reading

Naturopathy versus Science: Seasonal Allergy Edition

tilting at windmills

I glanced at my pharmacy license recently, and noticed I became a licensed pharmacist almost exactly twenty years ago. Two decades seems like a long time to do pretty much anything, yet I can still vividly recall some of the patients I encountered early in my career, working evenings in a retail pharmacy that drew heavily on the alternative medicine crowd. It was the first pharmacy I’d ever seen that sold products like homeopathy, detox kits, salt lamps, ear candles, and magnetic foot pads. And the customers were just as unorthodox. There were some that told me they manipulated their own pH, and others that insisted any prescription drug was designed to kill. And there was a huge clientele that relied on the pharmacy for their “bioidentical” hormones. It was an instructive learning experience, as it was as far from the science of pharmacy school as you could expect to find in a place that still called itself a pharmacy. One of the really interesting aspects of that pharmacy was the enormous supply of vitamins and supplements for sale. It stretched over multiple aisles and even back into the dispensary, where there were some brands kept behind the counter. This wasn’t for any regulatory reason – it was because these were the “naturopathic” supply, the brands often recommended by naturopaths. In order for this pharmacy to sell them they had to keep the products behind the counter, presumably to grant these supplements a veneer of medical legitimacy. These were “special”, and they had the prices to prove it. Continue reading

The Detox Myth: What your alternative health provider isn’t telling you

Herbal cleanse detox coffee enema sugar detox master chleanse

Happy New Year to my regular readers! Today’s post revisits some old material, repackaged and updated.

New Year, New You, right? 2014 is the year you’re finally going to get serious about your health. You’re winding down from a week (or more) of celebrations and parties. You’re pretty much recovered from New Year’s Eve by now. It’s time to make some resolutions. Conveniently, there is no shortage of solutions being advertised to absolve you of your sins while overhauling your body and soul for 2014: What you need to do is “detox”. You’ll see the detox kits at your local Whole Foods (or even your local pharmacy). Books, boxes or bottles, with some combination of “detox”, “cleanse” or “flush” in the product name. Supplements, tea, homeopathy, coffee enemas, ear candles, and footbaths all promise detoxification. The advertising suggests you’ll gain a renewed body and better health – it’s only seven days and $49.95 away. Or try to cleanse yourself with food alone: Dr. Oz is hyping his Holiday Detox plan. Bon Appetit is featuring their 2014 Food Lover’s Cleanse. Or what about that old standby, the “Master Cleanse”? It’s the New Year – wouldn’t a purification from your sins of 2013 be a good idea to start the year? After all, the local naturopath sells detoxification protocols, including vitamin drips and chelation. There must be something to it, right? Continue reading

Not an alternative to anything

Homeopathic vaccines

Health Canada approves homeopathic “nosodes” as “safe and effective” despite the fact that homeopathy is an elaborate placebo system of sugar pills based on prescientific ideas of disease. Homeopaths and naturopaths actively promote nosodes as alternatives to vaccines, despite the fact that homeopathic remedies are inert with zero ability to protect against infectious disease.

Due to lobbying by groups like Bad Science Watch, Health Canada has reluctantly agreed to label nosodes (which it approves for sale) with the caution “This product is not intended to be an alternative to vaccination”.  Is this adequate? Some are asking why nosodes are even permitted for sale at all: Continue reading

Ask the (Science-Based) Pharmacist: What are the benefits of coffee enemas?

How do you take your coffee? Rectally.

How do you take your coffee? Rectally.

It might not occur to you, sipping your morning coffee, that you could derive tremendous health benefits by simply shooting that coffee directly into your rectum. Yet many people believe this. Suzy Cohen, who calls herself, “America’s Pharmacist™” and also “America’s Most Trusted Pharmacist®” is a proponent. Her syndicated column Ask the Pharmacist recently contained this question and response: Continue reading