Naturopathic Debate Follow-Up: Some answers to your questions…
Answers to questions raised after a debate on whether doctors of naturopathic medicine should be recognized as primary care physicians in Quebec.
Before answering the following questions, let me state clearly that I have nothing to gain from being pro or con towards naturopathic or conventional medicine. I am not a physician so I have no financial stakes here. My participation in this debate stems solely from my interest in promoting evidence-based science. I am not on any sort of witch hunt against naturopathic practitioners, except when they practice quackery. The same goes for conventional medicine. I often attack conventional physicians who muddy themselves by profiting from nonsensical alternative treatments. Nobody has a monopoly on quackery.
I fully recognize that there is a role for naturopathic physicians in health care. They can provide valuable advice about lifestyle factors such as diet, exercise and stress relief, but I do not think their training is adequate for recognition as primary care physicians. I’m also bothered by the recurrent claim made by naturopathic doctors that conventional physicians treat “only the disease and not the patient,” and that they lack training in nutrition. Every medical school has courses in “physicianship” with an emphasis on dealing with the “whole” patient. True, because of the constraints of our medical system, doctors cannot spend as much time with patients as alternative practitioners. As far as nutrition goes, medical schools could certainly do more. But there is a whole discipline within medicine called dietetics. Dietitians are highly trained specialists to whom physicians refer. It is incorrect to suggest that conventional medicine neglects nutrition and that it is oblivious of the body-mind connection. Dealing with lifestyle factors is not solely in the domain of naturopathic doctors.
There is no doubt that naturopathy appeals to a segment of the population. Why? Some have become dissatisfied with conventional medicine and want to try another approach. Others suffer from chronic conditions for which medicine can offer little or from illnesses that have a strong psychosomatic component. These patients often find satisfaction in the compassionate attitude, the extensive history taking, the hands-on actions and the large dose of hope provided by naturopathic practitioners. But problems arise when some naturopathic doctors counsel against evidence-based conventional treatments. Suggesting that homeopathy is a viable alternative to antibiotics can have serious consequences. In my view, naturopathy is an eclectic practice that encompasses treatment modalities ranging from the sensible to the nonsensical and in its present format cannot be relied upon for primary care.
1. Do you know the difference between “Doctor of Naturopathic Medicine” and natural therapist or naturopath?
I certainly do. Doctors of naturopathy undergo training at a College of naturopathy, while basically anyone can call themselves a naturopath. I am, however, not impressed by some facets of the curriculum at these Colleges. After having closely scrutinized some lectures and student notes on chemistry, physiology and anatomy as taught in these institutions, my view is that the courses are not up to the rigor we teach in university. This is corroborated by a large investigation in Australia where a committee charged with accrediting schools of naturopathic medicine found that the syllabuses were reasonable but the actual instruction bore little resemblance to the publicized course.
Much more worrisome is that homeopathy is taught as a “science,” and that students in some schools are told that there are connections between the iris and the liver. Teachings about Traditional Chinese Medicine, reflexology, acupuncture and herbal medicine are one sided and ignore massive amounts of peer-reviewed research that does not support the naturopathic philosophy. I am also perturbed by that philosophy itself, which claims that given the right conditions, nature can heal all. Centuries of experience argue against that view.
Furthermore, I do not find evidence of consistent diagnostic or therapeutic methods in naturopathic medicine. One practitioner may offer totally different counsel from another and guidance can range from common sense advice about diet and exercise to an array of totally implausible treatments such as wearing socks soaked in ice water. Naturopathy can also encompass a hodgepodge of “allergy tests” that lack evidence and a grab bag of treatments that range from purging “toxins” through sweating to “detoxifying” the body by means of colonics. The “toxins” that are supposedly removed are never identified.
In one institution students are taught that homeopathy “works on a subtle, yet powerful, electromagnetic level to strengthen the body’s healing and immune response to provide a lasting cure.” “Subtle” here can be taken to mean scientifically undetectable. The Canadian Association of Naturopathic Doctors describes homeopathic remedies as such: “when carefully matched to the patient they are able to affect the body’s ‘vital force’ and to stimulate the body’s innate healing forces on both the physical and emotional levels, with few side effects.” This is nothing but fantastic conjecture.
The belief in some sort of supernatural “life force” that does not subscribe to the laws of chemistry, physics or biology and yet governs health is troublesome. Naturopaths commonly reference Hippocrates’ doctrine of “vis medicatrix naturae” (as if ancient “wisdom” equaled “evidence”) to justify the healing powers of nature. This is actually a misinterpretation of Hippocrates’ view. What the “father of medicine” had in mind was a purging of Greek medicine of its belief that gods were responsible for health and illness. Natural phenomena, not gods, were to be accountable, he maintained. Although science long ago confined “vitalism” to the dustbin, in naturopathic philosophy it lives on, unabated. That’s because “life force” is not a matter of science, but a matter of faith.
To sum up, naturopathic doctors are certainly more trustworthy than self-proclaimed naturopaths, but their treatments, ranging from the scientifically naïve to the evidence-based, are too varied and eclectic for these practitioners to be accepted as primary care physicians.
2. You mentioned that you accept no funding at all. Didn’t the OSS recently receive a 5.5 million dollar donation?
We do not accept any funding from any vested interest. We did indeed receive a $5.5 million gift from the Lorne Trottier Family Foundation. This was a generous donation from one of Canada’s leading philanthropists to ensure that the McGill Office for Science and Society has a continued existence. The capital cannot be touched, but we have the interest available to us every year. The money is used to fund the Lorne Trottier Public Science Symposium and also allows us to hire student interns and a full time communications coordinator and administrative assistant. Any other use of the funds is at our discretion. There are absolutely no strings attached to this gift. Dr. Trottier has a genuine passion for science and wished to ensure that our efforts to demystify science for the public continue far into the future.
At the OSS, our only allegiance is to the scientific method. We do not profit financially or otherwise by expressing our views. We do not sell anything, and frankly, it makes no difference to us how a product or a process is regulated, as long as the decision is arrived at through proper scientific methodology rather than anecdote, hearsay or magical thinking. In contrast to this, many doctors of naturopathy, as well as naturopaths, sell a variety of items to their clients. I consider this to be an unethical practice given the obvious motivation to recommend products from which the practitioner profits. Unfortunately, I have to add here that over the years I have purchased products and devices from both doctors of naturopathy and self-declared naturopaths that are firmly in the domain of quackery. These include various electronic gizmos, magnetic devices, disease-detecting dowsing rods and a wide assortment of pills and potions that are linked by one feature, a lack of evidence.
3. Many years ago, you were strongly against the use of vitamins, whereas Naturopathic Doctors had been using them for a long time. Now you are a big proponent of vitamins. Could it be that your methods and logic is simply behind Naturopathic Medicine, and that those things which you are now against, you will discover are legitimate in the future?
I was never “strongly against” vitamins and certainly am not a “big proponent now.” As with any other such issues, I take the path that is cleared by evidence-based science. That path of course can take various twists and turns. Indeed, that is part and parcel of the scientific method. Very few notions are etched in stone; science is a changing discipline and views change as more and more evidence comes to light. By contrast, arguments on behalf of homeopathy for example, have not changed in two hundred years. The justification offered by some naturopathic doctors is that “homeopathy was true then, is true now and will always be true.” Not exactly scientific thinking.
There is no question that vitamins play a significant role in preventing deficiency diseases but these are not conditions that are seen in the developed world. Taking vitamins as “nutritional insurance” has not been demonstrated to be effective. In contrast, studies are emerging that cast a shadow on the wisdom of taking supplements in a random fashion. It is clear that vitamins are not necessarily innocuous. The emphasis should be on a balanced diet. The one vitamin supplement that can be considered in terms of a positive risk-benefit profile is vitamin D although it is not clear what the optimal dosage is.
4. Would you be willing to work alongside a Naturopathic Doctor practicing homeopathy and see the progression of the patient treated with homeopathy?
This question itself demonstrates part of the problem the scientific community faces with homeopathy. Nothing can be learned from watching the progression of one patient. People get better for all kinds of reasons. Many diseases just resolve with time, others have periods of remission and then of course there is the placebo effect. That’s why we go for double blind randomized trials. And these demonstrate that homeopathy works through the placebo effect.
5. So, if we are all on the same page that naturopathic doctors should be regulated and legalized, will you help us get there? Let’s team up to regulate the profession and protect the public!
My Office would be glad to support any regulatory process that promotes evidence-based science and tackles quackery. But we would not support the acceptance of naturopathic doctors as primary care physicians for the simple reason that their training is not equivalent to that of medical doctors who have gone through residency. The philosophy of using no medications is not compatible with primary practice and there are various medical conditions that can readily be picked up by a physician who has had years of hospital experience but are outside the scope of a naturopathic practice. Even where naturopathic doctors have a residency program, which is rare, it is in a naturopathic clinic, not in a proper hospital environment.
6. How can there be enough evidence for naturopathic medicine when pharmaceutical companies and government will not fund the research?
Actually, a vast amount of research has been carried out on every aspect of naturopathy. The National Center for Alternative and Complementary Medicine in the U.S (hardly an “establishment” organization). has spent close to $3 billion over the last thirteen years and has very little to show for it. Echinacea for colds, ginkgo biloba for memory, glucosamine and chondroitin for arthritis, black cohosh for menopausal hot flashes and saw palmetto for prostate problems, all of which are mainstays of the naturopathic arsenal, have proved to be no better than placebos. The lone exception: ginger capsules may help chemotherapy nausea. As for therapies, acupuncture has been shown to help certain conditions, and yoga, massage, meditation and other relaxation methods may relieve symptoms like pain, anxiety and fatigue. There has also been extensive research sponsored by pharmaceutical companies, many of which market vitamins and various supplements. Again results are hardly compelling. Boiron is a giant pharmaceutical company (using the term loosely) that makes homeopathic preparations. Should it not be sponsoring proper double blind studies of its products? Of course it should. But it doesn’t, because their products sell anyway, no evidence required.
7. Having admitted that the human body is the most complex organism on earth, what will it take for you to concede that there is much more to true health than current science can explain?
Another question that demonstrates confused thinking. Science does not, and never has claimed to have all the answers. Science is a process, a quest for knowledge. Of course there is more to health than what science can presently explain. But just look at how much it has explained. We now know about bacteria and viruses. We know about prions. We know about genetic factors. We know about oncogenes. We know how allergies are manifested. We know about links between diet and health. We know about psychosomatic illness. We know about the effects of bacterial flora in our gut. And we know a lot about the placebo effect. But of course we don’t know everything. So, any scientist will readily “concede” that there is more to health than current science can explain. That does not mean we should uncritically swallow theories about what the “more” is. Implausible speculations about water having “memory,” or about anatomically non-existent meridians or “blocked energy channels” amount to no more than magical thinking and have no place in evidence-based science. It is proper research, not fanciful, seductive conjecture that will allow us to learn just what “more” there is to good health. Naturopathic doctors may provide a sympathetic ear but that does not guarantee a discerning brain.