The truthiness of naturopathic “facts”

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.

It’s for this reason that I’m baffled by the suggestion that medicine needs to “integrate” alternatives-to-medicine treatments. I understand the principles of homeopathy, acupuncture, and naturopathy. And those principles are antagonistic to science-based medicine. Imagine working with someone calling themselves a health professional that believes that they can restore a patient’s “vital force” by giving remedies that are pure water. Or stick needles in the skin to stimulate nonexistent “meridians”. Or even decide what scientific evidence they’re going to accept and use – not based on the strength of the evidence, but on a pre-scientific belief system. That’s naturopathy in a nutshell, which is one of the oddest alternative health practices out there. It’s not just homeopathy, or herbalism, or acupuncture. It’s all the above, and more. The central belief, “vitalism”, posits that living beings have a “life force” not found in inanimate objects. Vitalism as a concept was disproved by Wöhler in 1828, yet the idea continues to thrive in naturopathy. Naturopathic treatment ideas are all grounded in the idea of restoring this “energy”, rather than being based on objective science. It is perhaps unsurprising that naturopathy has evolved to include disparate practices like homeopathy, acupuncture and herbalism. Given there’s no requirement to justify or rationalize practices in scientific terms, pretty much anything goes, as long as it aligns with the underlying philosophy. Not all naturopathic advice is bunk – some can be evidence-based. However, that’s not because it’s grounded in evidence, but rather despite it: sometimes medical advice happens to align with the naturopathic philosophy. I’ve used this naturopath’s quote before, but from my perspective it concisely sums up how naturopathy likes to pick its own facts.

I love being able to look at new approaches that may come along and to ask myself, “Is this within the bounds of the philosophy I so embrace?” And if not, to let it go.

– Amy Rothenberg, Naturopath

Perhaps not surprisingly, there are numerous criticisms of naturopathy in the literature, and surveys of the services offered by naturopaths confirm that naturopathy as it is actually practiced does not appear to be science-based nor evidence-based. This type of data isn’t helpful to naturopaths that are pressing to be treated as medical professionals akin to medical doctors. Naturopaths have been fighting for “integration” as health professionals for some time, and they believe themselves to be capable of providing primary care like family physicians. And despite the fact that naturopathy is grounded in an unscientific belief system, naturopaths claim repeatedly that their practices are science-based, recognizing that legislators (and the public) generally places a high value on science. Naturopaths even describe naturopathy as “science-based natural medicine“. The AANMC claims:

Because today’s naturopathic doctors (NDs) believe in understanding patients from the cellular level up, they actively pursue the latest biochemical findings relating to the workings of the body and the dynamics of botanical medicines, nutrition, homeopathy and other natural therapies. Their diagnoses and therapeutics are science based and increasingly evidence based. While the training and approach of naturopathic physicians is progressive, naturopathic physicians practice in ways reminiscent of old-fashioned family doctors. They take the time and make the effort to learn about each patient and his/her family.

For some reason I keep returning to blog about naturopathy because it’s the one alternative-to-medicine practice that seems to genuinely confuse the public. Even those that might be a bit wary of an acupuncturist or herbalist might be willing to give a naturopath a try – after all, many states are granting them health professional privileges. So the marketing is working. But criticisms of naturopathy are not hard to find, either. One place that alternative medicine practices get a fairly rough ride is Wikipedia. I have mixed feelings about Wikipedia. It can be inaccurate. But I use it, and you probably do too. As a starting point to research, rather than the final word, Wikipedia can often be quite useful. And there is no denying its popularity. Given Wikipedia’s popularity and search ranking, it should not come as no surprise that alternative medicine providers and advocates want Wikipedia to support their own practices. But Wikipedia’s contributors are generally quite critical of alternative medicine, given it lacks scientific support. Earlier this year an alternative medicine group started a change.org petition asking Wikipedia’s founder Jimmy Wales to create and enforce new policies that “allow for true scientific discourse about holistic approaches to healing.” It seems they didn’t like the nasty editors who “used the narrowest possible understanding of science to inhibit ‘open discussion'”. Wales responded in a way that made advocates of science-based medicine smile:

Every single person who signed this petition needs to go back to check their premises and think harder about what it means to be honest, factual, truthful. Wikipedia’s policies around this kind of thing are exactly spot-on and correct. If you can get your work published in respectable scientific journals – that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately. What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse”. It isn’t.

If you don’t like the facts, invent your own

All of this leads me back to a naturopathic resource I stumbled onto a few weeks ago. Created by naturopaths (and edited by naturopaths only), ndhealthfacts.org is intended as a resource for naturopaths and their patients, so naturopaths can provide information that is presumably more oriented towards naturopathic practices (without all those nasty skeptics). While anyone can create a wiki, this one is notable for its ownership. It is edited by one of the “leaders” in naturopathic circles, Iva Lloyd. According to her bio,

Dr. Lloyd founded Naturopathic Foundations Health Clinic in 2002 after graduating from the Canadian College of Naturopathic Medicine (CCNM). She is editor of the Vital Link, the professional journal of the Canadian Association of Naturpathic [sic] Doctors (CAND), and she is on the editorial board of other professional journals. She teaches part-time at the CCNM and she presents internationally on naturopathic assessments, the energetics of health and the role of the mind in healing.

As the editor of a journal published by Canada’s national naturopathic organization, Lloyd’s participation should mean that ndhealthfacts provides information that accurately describes the naturopathic philosophy and treatment system. Given that only naturopaths are allowed to edit ndhealthfacts, yet the wiki is written for the public, the entries can reasonably be assumed to illustrate the current naturopathic consensus, as well as give insight into a world without criticism. With that in mind, let’s look at some of the entries, contrasting it with other resources. I’ve pulled excerpts, with links so you can do your own evaluation. Post any other notable entries you find in the comments:

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Naturopathy (ndhealthfacts):

Naturopathic medicine is a distinct system of primary health care derived from a strong philosophical belief about life, health, and disease. Its principles and philosophies are an integral component of naturopathic assessment, diagnosis, and treatment. Naturopathic medicine promotes wellness and prevention. It blends modern scientific knowledge with traditional and natural forms of medicine and it emphasizes disease as a process rather than as an entity.Naturopathic medicine is defined by principles rather than by methods or modalities. Above all, it honors the body’s innate wisdom to heal. The emphasis of naturopathic therapies is to treat the causes of disease and to stimulate the healing power of body by using natural techniques and therapies. Naturopathic doctors diagnose and treat both acute and chronic conditions and treat patients of all ages.

Naturopathy (Wikipedia):

Naturopathy or naturopathic medicine is a form of alternative medicine employing a wide array of “natural” treatments, including homeopathy, herbalism, and acupuncture, as well as diet and lifestyle counseling. Naturopaths favor a holistic approach with non-invasive treatment and generally avoid the use of surgery and drugs. Naturopathic philosophy is based on a belief in vitalism and self-healing, and practitioners often prefer methods of treatment that are not compatible with evidence-based medicine. Naturopathic medicine is replete with pseudoscientific, ineffective, unethical, and possibly dangerous practices.

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Vis medicatrix naturae (Healing Power of Nature) (ndhealthfacts):

The term vis medicatrix naturae which means the healing power of nature was established by Hippocrates to denote the body’s ability to heal itself or innate healing. This healing power is an inherent self-organizing, ordered healing process of living systems which establishes, maintains and restores health. The Vis Medicatrix Naturae is the power of nature to heal, an extension of creator consciousness or cosmic consciousness. While everything on the planet has become somewhat disharmonious, this energetic template or spiritual blueprint is held, inviolable, within our nature and is made avilable [sic] as a [sic] exemplar during the process of healing.

Vis medicatrix naturae (Healing Power of Nature) (Wikipedia):

In the nineteenth-century, vis medicatrix naturae came to be interpreted as vitalism, and in this form it came to underlie the philosophical framework of homeopathy, chiropractic, hydropathy, osteopathy and naturopathy.^[5] As Bynum notes, “Search the Internet for vis medicatrix naturae and you will find yourself in the land of what we now politely call ‘alternative’ or ‘complementary’ medicine”.

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Homeopathy (ndhealthfacts.org):

Homeopathy is an energy medicine system. The challenge with most current research techniques are that they are not designed to evaluate this form of medicine. Yet even still, there is a growing body of research that supports the use of homeopathy.

Homeopathy (Wikipedia):

Homeopathy is a system of alternative medicine created in 1796 by Samuel Hahnemann based on his doctrine of like cures like: a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people. Homeopathy is considered a pseudoscience, and its remedies have been found to be no more effective than placebos.

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Adrenal fatigue is a fake disease commonly diagnosed by naturopaths.

Adrenal fatigue (ndhealthfacts.org):

Adrenal fatigue is a term used to describe “hypo” functioning adrenal glands. Excess physical, emotional, and psychological stressors can deplete the adrenal glands causing a decrease in output of adrenal hormones, especially cortisol. This can have a profound effect on the body.

Adrenal fatigue (Wikipedia):

Adrenal fatigue or hypoadrenia are terms used in alternative medicine to describe the unproven belief that the adrenal glands are exhausted and unable to produce adequate quantities of hormones, primarily the glucocorticoid cortisol. Adrenal fatigue should not be confused with recognized forms of adrenal dysfunction such as adrenal insufficiency or Addison’s Disease. The term “adrenal fatigue”, which was coined in 1998 by James M. Wilson, may be applied to a collection of mostly nonspecific symptoms. There is no scientific evidence supporting the concept of adrenal fatigue and it is not recognized as an actual diagnosis by the medical community.

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Another fake disease is candidiasis, when diagnosed by a naturopath:
Candidiasis (ndhealthfacts):

Candidiasis, or Candida albicans is the most prominent fungal infection and it is commonly associated with both acute and chronic diseases. All fungal infections grow better when the immune system is weaker. Aging individuals tend to have weaker immune systems, accounting for the higher rate of fungal infections with increased age. Candida is a yeast infestation that begins in the digestive system. It is a strong, invasive fungus that attaches to the intestinal wall and can spread to other areas of the body (sinuses, ears, reproductive tract). Candida overgrowth has been shown to cause symptoms in nearly every body system with the most noted symptoms arising from the gastrointestinal, genitourinary, endocrine, nervous, and immune systems.

Candidiasis (Alternative medicine) (Wikipedia):

What has been described as “a large pseudoscientific cult” has developed around the topic of Candida, with claims up to one in three people are affected by conditions with terms such as systemic candidiasis, “candidiasis hypersensitivity”, fungal type dysbiosis, Candida-related complex, the yeast syndrome, yeast allergy, yeast overgrowth, or simply “Candida” or “yeast problem”. Some practitioners of alternative medicine have promoted these purported conditions and sold dietary supplements as supposed cures; a number of them have been prosecuted.

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You can see the impact of a little skepticism. While Wikipedia may not be 100% accurate in its articles, overall it summarizes the scientific evidence and consensus much more accurately. There are also dozens of supplement monographs. Here where the risk of harms becomes even more apparent:

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Black Cohosh (ndhealthfacts): Claimed to be useful for whooping cough. Also notes, “Very effective for menopause if used for 2-6 months as alternative to HRT (hormone replacement therapy)”. Makes no mention of treatment risks.

Black Cohosh (UptoDate): Black Cohosh “does not appear to be more effective than placebo for reduction of vasomotor symptoms”. The reference also mentions a possible estrogenic effect of black cohosh, and cautions against use in women with breast cancer.

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The most telling statement on ndhealthfacts, and about naturopathy in general, may be the entry on naturopathic research:

There are many ways in which the scientific method is used and applied appropriately to naturopathic medicine, but there are also many ways in which this method is neither appropriate not applicable.

Conclusion

Naturopaths claim that they practice based on scientific principles. Yet examinations of naturopathic literature, practices and statements suggest a more ambivalent attitude. NDhealthfacts.org neatly illustrates the problem with naturopathy itself: Open antagonism to science-based medicine, and the risk of harm from “integrating” these practices into the practice of medicine. Unfortunately, the trend towards “integrating” naturopathy into medicine is both real and frightening. Because good medicine isn’t based on invented facts and pre-scientific beliefs – it must be grounded in science. And naturopathy, despite the claims, is anything but scientific.

Photo from flickr user hebe used under a CC licence.