Steve Thoms' points against naturopathy

By Grant Jacobs 02/12/2009 8

Science-based medics and researchers baulk at many of the claims of naturopathic remedies.

While reading an article on Science-Based Medicine about the battle against  legislating the naturopathic industry in Ontario, Canada, a comment pointed to a comment by Steve Thoms, Editor-in-Chief of Skeptic North in another blog which listed points against naturopathy.  (See steveisgood Nov 27 2009 1:11 Pm in this blog.)

David J Kroll (PhD) describes naturopathy in the opening passages of his article at Science-Based Medicine:

Naturopathy, sometimes called naturopathic medicine, is an unusual and inconsistently regulated alternative medical practice that co-opts some evidence-based medicine, often in nutrition and natural product medicines, but also subscribes to ’vitalism’ (vis medicatrix naturae) and makes use of homeopathic remedies that defy the rules of physics and dose-response pharmacology.

Before I list Steve’s points, Kimball Atwood’s article Naturopathy: A Critical Appraisal is worth reading for more detailed background. (Some will note that naturopathy shares with chiropractic the retention of a 19th century belief in vitalism.)

I’ve excerpted some of Steve’s points, occasionally adding my own thoughts in square brackets, keeping his original point numbers so that you can see what’s missing.

His opening paragraph is well worth noting:

The science-based community is always at a disadvantage in these sorts of outcries, because we’re limited to the evidence, and we can’t just make stuff up. There’s a lot to respond to.

2) The assertion that the body has the potential to heal itself is not a scientific one.  When given “natural” support only, the body will die by the age of 45, probably of infectious diseases.  Modern advances in medicine make long-life possible, not herbs and roots from a 2,000 year old playbook.

3) Saying “science” doesn’t make it so. The call of “the healing power of nature at work” to be not magic, but good science, is ridiculous on its face….the human body is really good at succumbing to pathogens and injury, and the “natural” world is really good at killing us.

4) Old and tradition do not a science make.  Yes, herbal supplements have been around for centuries.  So has prostitution. Old doesn’t mean effective.  It means old.  I want my medicine to be new, awesome, and if possible, administered by a robot from the future.

[I’ve two minds about the robot bit, but it does sound snazzy.]

5) Regulation does not a science make, even if it was 85 years ago.

[It’s the testing, not the legal stuff that matters. Shades of Professor Frizelle’s “instant classic”: Let’s hear your evidence not your legal muscle. (Prof. Frizelle hails from Christchurch, New Zealand, and is editor of the New Zealand Medical Journal. Her original article is available on-line.)]

7) Why the natural fetish?  If you’re dying from a disease, do you really care if your treatment is “natural” or not?  Why take an herbal supplement that a person tells you *might* work, when you could take the most recent advances in medical technology that we know *will* work?

[I’d add that there’s a tendency to play the “natural” line to imply that “synthetic” is bad. This ignores that the same active ingredients are in both.]

8) Natural doesn’t mean safe.  It doesn’t mean effective.  Arsenic, poisonous mushrooms, gravel and bird-crap are also natural and you don’t see me putting them into my body.

[“Natural” is often played as a marketing line, rather than anything of real meaning. What is relevant is what the active substances are, what they do, the evidence supporting claims of what they do, the dosage, and so on. As I wrote when discussing genetic tests, under the heading ‘Care over ’alternative medicine’ claims’: If someone makes a claim about a health product that cannot be substantiated by evidence, then they cannot say it is a medicine, only that they hope that it might be a medicine.]

9) Lets not forget that many people see a naturopath because they’re dazzled by the word “Naturopathic Doctor, or ND”.  Let’s be perfectly clear: Naturopaths are NOT doctors. The Naturopathy Act, 2007 allows them to be called “Naturopaths”, not “doctors.”  You need to go to medical school to be called a doctor.  Naturopaths just granted themselves that title as a subtle PR stunt.

[The details here are specific to Canada, but the general point remains. For example, chiropractic “doctors” in NZ are not medical doctors and are not on the medical register.]

10) What is the diagnostic method a naturopath uses to test if a body is “in balance”?  What laboratory equipment can you use to check for “wellness”?

12) If naturopathy is just as effective as medicine, then why don’t these naturopaths just go to med school?

13) The medical community is constantly advocating good health, diet, nutrition and exercise…naturopaths don’t have a monopoly on knowing the merits of preventative health.

[This one seems to be overlooked an awful lot. See Amanda’s post on vitamins which in passing illustrates this.]

15) The length of time for training is meaningless if the education quality is so lackluster.  I can study levitation for 20 years but it doesn’t mean that I could fly.

16) “Every review of our record has recognized the safety of the more natural approach of naturopathic care.”  Every review? Really?  Black Cohosh, anyone?

[I’d add that safety is not effectiveness. Water is safe, except in huge excess. Remedies that don’t do anything can be safe because they don’t do anything!]

17) The authors conveniently left out the deaths attributed to naturopathic prescriptions in Washington and Oregon, showing once again their contempt for honest data-gathering and fondness for cherry-picking whatever information suits their pre-conceived narrative.

[The example is perhaps specific to their case, but the general message to always watch out for cherry-picking of “evidence” is worth bearing in mind. Cherry-picking data it’s a sign that the person is pushing their point of view in a biased way.]

23) This is not about freedom of choice for the patient, and it never has been.  This is about granting naturopathy legislative and legal legitimacy because it can’t do so under the rules of science and evidence.

[Many would argue that this “seeking legitimacy” is a characteristic theme of many marginal or unscientific “medical” groups. A key thing in my mind is to regulate the claims made and to ask if groups are prepared to limit themselves to claims that they can back with scientific evidence and if not, they shouldn’t be granted legitimacy. Legitimacy should come from the evidence backing the  claims, not the legal stuff.]

Other posts on health or medicine in Code for life:

Neti pots now validated as sound science?

The chiropractor really should stick to bones

Genetic tests and personalised medicine, some science communication issues

Genetic tests and personalised medicine

Autistic children and blood mercury levels

What the chiropractor said

Metagenomics-finding organisms from their genomes

Medical remedies-burden of proof lies with seller

8 Responses to “Steve Thoms' points against naturopathy”

  • There are many questionable elements in the broad area that makes up “naturopathy”, but this is a very poor critique thereof. (I can’t access the.Atwood article, so I’m relying on your summary of Steve’s summary).

    Firstly let me be clear that I’m not a mystical vitalist – although whether vitalism is at all valid is a more difficult question that science alone can solve, I suspect, and I don’t know you can can all of naturopathy on that basis alone. But the other points also have issues:

    #2 is not true. Not everyone pre-modern medicine died before 45.
    #3 is half bollocks and half obvious.
    #4 is also logically dodgy – prostitution is a poor analogy, and old can mean good (but may not, then again some new ain’t so good either).
    #7 tries to form an absolute in the domain of a preference. I suggest there is a continuum of responses to medical misfortune (and understanding thereof) among patients. If I were dying of cancer I would be happy to try some harsh modern chemical treatments – but others may not. but others may be happy to find the modern pharma way to solve all medical problems, while I and others are happy to use basic herbal treatments for basic conditions. And, “know will work”? Pfffft.
    #8 Yes, but neither does synthetic.
    #9 Don’t care. I’ve had good and bad medical help from both official and non-official practitioners.
    #10 Dunno, but bear in mind modern medical diagnosis ain’t flawless either. That said, I’d tend towards preferring modern diagnostics rather than alternatives in many cases.
    #12 Who said it was, for all problems? And, “because med school doesn’t teach naturopathy? Duh.
    #15 Way to go, assuming your conclusion!
    The rest don’t add much to the debate, are irrelevant, or gloss over parallel deficiencies in modern medicine.

    Overall, a disappointing read.

  • Of course not every pre-medicine died at 45 but that was the average age. And the point of #7 and 8 is that everything needs to be tested and held to the same standard, regardless of how it is made or what it is made from.

    As far as #15 goes has anyone ever provided evidence that they can fly after studying levitation for 20 years ….. [crickets chirping, tumbleweed blows past} … I thought not.

    As for #12 med schools do not teach naturopathy certainly not as a whole. What they do teach (or at least should teach) is the stuff that has been shown to work.

    If you can show parts of narturopathy actually works under a scientific standard (preferably double blind) then it would be come part of medicine (and taught at med schools) and until then it is just bogus claims.

  • Readers can get access to Kimball Atwood’s paper if you register for Medcape. It’s a bit of a long-winded registration mind you, but it’s a good article.

    rainman: Look to the meaning that’s being conveyed in the points. Nit-picking details can be just a way to procrastinate or not face the meaning being conveyed 😉

  • This is just a sloppy attempt to ridicule naturopathy, rather than to accurately address concerns about it.

    “When given “natural” support only, the body will die by the age of 45, probably of infectious diseases.”
    Simply false and you know it. I don’t know of any alternative practitioners that are not grateful for access to antibiotics. It is also the case that irresponsible use of antibiotics is taking all of humanity into some very dangerous territory. Infections are a huge factor in the low average life expectancy of many societies in the past. Currently we have access to antibiotics, and there are many situations when they should be promptly applied. Maybe there are some quacks that seriously believe that no unnatural treatment should ever be applied, but I don’t know of a single person with such a perspective in the large community of clinical herbalists and students that I’m a part of. Pointing to a decreased average lifespan among people who did not have access to antibiotics does not discredit the value of an approach to supporting health that involves utilizing herbal medicines and other effective natural healing modalities. Also, suggesting that the average lifespan of a person in a society, which factors in infant mortality as well as death by matters unrelated to disease and aging such as violence, is a measure of when the body is likely to shut down on itself is absurd and inaccurate.

    The idea that people really believe that the body does not have a constant momentum toward balance and healing is bizarre to me. Every micro and macrocosmic level of life shows the same patterns; the constant maintenance of homeostasis is the basis of healing. Remove obstructions to that momentum toward balance (maybe a nutritional deficiency, physical inactivity, etc) and the body can more effectively move back into health. Vitalism is just a poetic way of recognizing this tendency as well as the basic mystery of life. We don’t know what animates life, and never before has it been seen as being so inappropriate to attempt to make sense of these mysteries. Yes, vitalist medicine does represent a very different paradigm of supporting health than conventional medicine in many ways other than the recognition of the concept of a “vital force.” Vitalism says “Yes” to many things that conventional medicine says “no” to. Vitalist medicine is much less likely to suppresse a fever, or a cough, or to dry mucous membranes, or any other ways of negating the natural healing responses of the body. Sometimes it is necessary, but not nearly as often as is usually done.

    I agree that the natural medicine scene is full of dangerously misleading ideas about health. There are countless phisolosphies and practices that fall under this umbrella that I am hugely skeptical of. I am a student of an approach to herbal medicine that draws strongly upon scientific research, without discrediting thousands of years of empirical data. If an herb is used for the same purposes in multiple parts of the world and has been for a long, long time, and herbalists of the past have recorded thousands of case studies suggesting effectiveness for that use, and I have also personally witnessed experienced it seeming to show benefit, I don’t need to see a large, peer-reviewed, double-blinded study (that likely would never be funded) on it in order to feel confident in using it in my practice. Similarly, I recognize that there is information that has been parroted from one herbalist to another thoughout history, but when it comes to my own experiences, if I don’t see it working, and can’t make any sense of why it might be useful in this way based on all the other information I have about it (knowledge of constituents, ethnobotanical information), then I’m not going to use it and I’m going to share my experiences with other practitioners.

    The strong concern and skepticism of CAM as a whole is totally legitimate, but I do feel strongly that skeptics are all too willing to toss the baby out with the bathwater. Herbal medicine has so much potential to support conventional treatment. Conventional medicine offers powerful lifesaving interventions, but often its attempts at palliative care are wreckless and harmful. The statistics on yearly deaths from NSAID use are a good example of this. Why aren’t these people’s doctors putting in the hard work of figuring out the cause of the inflammation and working with methods to heal the fundamental imbalance, or at least putting up a resonable ethical resistance to using these drugs that are killing shocking numbers of people every year, while effective alternatives that are increasingly supported by scientific research exist?

    Does conventional medicine have remedies that gently support immune function that can be taken as effective preventative medicine? Herbal medicine does, and new research to validate these remedies is coming out all the time. Some of these are so effective that they are even useful in supporting immune function in cancer treatment. Check out the NIH’s big recent study on Turkey Tail mushroom on women with breast cancer. This is really exciting stuff.

    I have a friend who was extremely high-strung, anxious, angry.. she had 3 loud dogs that never stopped barking and she screamed at them “SHUT UP! at the top of her lungs multiple times a day. I once witnessed her pull out her knife and wave it at someone out the car window on the highway. I had never seen such an extreme example of this sort of personality. She drank lots of vodka, and smoked lots of cigarettes. She started experiencing tiredness at work, and fell asleep in a couple meetings. She went to the doctor and came home with an adderall prescription. All of the intense aspects of her personality became more pronounced, but she was getting so much done at work and was really excited about it. Over the course of a couple years, her dose was bumped up more and more, until she was at 60mg XR per day. One day she fell unconscious while cooking dinner with her family. An ambulance took her to the hospital, where it was found that she had TWO slow-bleeding anyeurisms. It is a miracle she didn’t die before reaching the hospital, and it is something like a miracle that the technology exists to treat this condition in cases where it doesn’t cause sudden death. After getting the aneurisms treated, the doctor told her she should probably stop smoking cigarettes, and sent her on her way. She continued taking high doses of an amphetamine drug that has her adrenals running on fumes, continued drinking vodka, and did nothing to modify her high-stress fast-paced lifestyle.

    How would a good herbalist have handled this situation? They would likely have given her an herb or formula that supports and relieves inflammation in the liver (some bitter herb), calms her nerves allowing her to get better sleep, and has an adaptogenic properties to support her immune function. They likely would have talked with her for a while to figure out some ideas of ways she can better cope with stress and and better support her overall health. Maybe she would be interested in some support in strategizing ways to bring down her consumption of alcohol and cigarettes, recognizing that both of these can contribute to fatigue. It would also be a mistake to overlook the importance of finding a doctor who is willing to do the right thing and test for various more serious possible causes of fatigue (nutritional deficiencies, thyroid problems, lyme disease, mono, etc). Such a considerate approach actually offers the potential of healing, instead of an immediate introduction into a lifetime of increasing dependency to a pharmaceutical drug.

    This herbalist isn’t anything like the sort of lunatic that might whip out their set of homeopathic remedies instead of calling 911 when she was their lying on the kitchen floor. I really don’t think it is reasonable to lump them together.

    Imagine for a second that there are good, effective herbalists in the world. Their understanding of nutrition and lifestyle factors in health are accurate and up to date. They are well-versed in much of the current scientific research about medicinal plants. They are clued into some less common but still scientifically supported therapies such as utilizing intermittent fasting to help regenerate an intestinal lining thinned by NSAID use. They also, whether you like it or not, fill out their practice with traditional western herbal practice, carefully considering the “energetics” of the herbs they choose. A pretty basic example of this is the case of choosing between an herb like ginger or one like dandelion for someone with sluggish digestion. One will be much more effective than the other, and traditional medicine systems all around the world have developed very similar ways of making such distinctions. (No herbalist claims that the language used (a cooling herb or a warming herb) is scientific, but this does not mean it does not effectively steer the practitioner toward the most appropriate remedies.) I wonder if you think that this practitioner would have any potential of being an ally to MDs, meeting some needs that modern medicine does not meet. I dream of working alongside conventional practitioners in a synergistic and mutually respectful way. There are some schools that are actually doing a really good job training people to be effective and responsible holistic practitioners, but they are very few.

    • Too long for me to reply to you many points (at this time) but note if there was clear evidence something worked, and could be delivered in a practicable, efficacious way, then it would be ‘conventional practice’. (Provided there was no obviously better alternative; same for when a better drug displaces an older one.)

  • Grant,
    I’m going to have to agree with Rainman with regards to the article you have quoted from. A lot of the phrasing is very sloppy. If Steve meant that without medical intervention the average lifespan would be 45 years then he should have said so.
    If one is going to argue against naturopathy or any other pseudoscientific belief then you need to be precise and accurate in the arguments that are used.

    Your description of how a herbalist would treat the high strung person you described is very similar to what a good doctor would do (minus the herbs) so I think that part of your argument is a bit of a strawman. Also, a good doctor will recommend healthy diet, not smoking, moderation of drinking etc – these are definitely not the exclusive domain of “alternative health” purveyors.

    Also, you have switched from talking about naturopathy to herbalism, which is probably the most legitimate part of naturopathy – it also ignores that naturopathy typically includes pseudoscientific approaches such as homeopathy.

  • “herbalists of the past have recorded thousands of case studies suggesting effectiveness for that use, and I have also personally witnessed experienced it seeming to show benefit, I don’t need to see a large, peer-reviewed, double-blinded study (that likely would never be funded) on it in order to feel confident in using it in my practice.”

    I’ve seen it said that the most dangerous 3 words in medicine are “in my experience”. Anecdotes and case studies have an appropriate place in the hierarchy of evidence, but that place is not informing clinical practice.

    At most, they can be useful when determining which research avenues are most likely to be productive to pursue. Relying on them for clinical practice is risky though.

    Anecdotes have the dangerous combination of both being very convincing and having the capacity to be completely misleading. In order to exclude all the biases inherent in individual cases – such as the placebo effect, random variation, regression to the mean, and the natural course of illness – and tease out the useful information we need to conduct rigorous trials, involving bias reducing measures such as large sample sizes, randomisation, and both practitioner and patient blinding.

    Herbal medicine obviously has a lot to offer, and you’re right that we shouldn’t throw out the baby with the bathwater. But in order to tell one from the other we need to perform that research you say you don’t need to see. Relying on anecdotes simply isn’t sufficient.

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