Naturopaths and the creep of pseudoscience
Sadly, the creep of pseudoscience – as manifested in the provincial legitimization of unproven alternative approaches to health – continues. Ontario naturopaths are pushing hard to become a self-regulating profession, with expanded rights to prescribe drugs and order tests. Thankfully, the Ontario Medical Association is pushing back.
This is not a turf war – there are more than enough patients out there. Nor is the resistance from the medical community founded on a fear of a loss of professional status. This is about patient safety and, more fundamentally, the role of science in the Canadian health care system. Naturopathic medicine, despite claims to the contrary, is not an evidence-based approach. Given this reality, provincial health ministries need to carefully consider the long-term implications – including the legal and ethical challenges – of formally legitimizing the pseudoscientific.
If naturopathic medicine were governed by science, as practitioners increasingly claim, they would not provide: detoxification services, homeopathic remedies, most herbal remedies, and cosmetic facial acupuncture. But these types of services are, as evidenced by clinic websites, the core of naturopathic medicine. If you don’t believe me, I invite you to Google “detoxification and naturopath”. You will get a list of clinics offering things like colon cleanses (useless, potentially harmful, and a bit disgusting), ionic foot baths that create an “energy field similar to that found in the human body” (so scientifically ridiculous that it borders on parody), and infrared sauna therapy (ditto).
Lucky for naturopaths they are not bound by science. I do not mean that the laws of physics do not apply to the things that happen within the walls of naturopathic clinics. I am fairly certain an apple will still fall, the Earth still orbits the Sun, and the application of the scientific method would still nudge us closer to the truth about the therapies they deploy.
Rather, I mean that the profession is not wedded to a scientific worldview. It is a practice built around a philosophical framework based on the alleged “healing power of nature” or, to quote the Canadian College of Naturopathic Medicine, the “principle of healing through the cooperative power of nature” and the “individual’s inherent self-healing mechanisms.” This kind of rhetoric may sound inviting, particularly since it plays to eternally popular and consistently unsupportable idea that “natural” is always better (try consuming some arsenic, tar sand, or mercury). It is, however, scientifically meaningless.
What naturopaths – and, for that matter, other alternative practitioners – increasingly suggest is that they are in a position to integrate the best of both conventional and alternative practices. They can, or so they claim, slide between the worlds of pseudoscience and science. They can offer ionic footbaths and, at the same time, push provincial governments for the right to provide patients with more conventional, and potentially harmful, procedures and drugs.
Putting aside the boatload of conceptual and patient care issues associated with legitimizing magical thinking (the recent death of a 7-year-old Alberta boy who was given homeopathy instead of real medicine is a tragic example), there are many profound, and often overlooked, legal and ethical challenges associated with seeking to integrate a pseudoscience-based practice into our health care system.
To cite just one example, how will the informed consent process work? In Canada, health care providers must tell patients anything a reasonable person in the patients’ position would want to know. As such, a science-based approach to the provision of a homeopathic remedy would, for instance, require the practitioner to tell a patient that other than a possible placebo effect the treatment does not work and that it is scientifically implausible. Any other approach would be both unethical and fail to meet the legal standard of informed consent. A similar approach, by the way, would be required for the ionic footbath.
I call this the two-hat fallacy. A naturopath can’t, from the perspective of the patient, switch between wearing a “science hat” and “pseudoscience hat.” If you are a science-informed profession, than this is the standard to which you should be held. If naturopaths are given the opportunity to provide potentially lethal drugs, what approach to informed consent will they use? Will they put on their “science hat” (as would seem to be required by some regulations)?
Of course, there are also problems associated with naturopaths’ knowledge about and approach to science. Studies have found that naturopaths view the value of evidence differently than conventional practitioners. For example, a US study found that only 24% of naturopaths found the “results of randomized controlled trials as ‘very useful.’”
I am fully aware of the many deficiencies of conventional medicine, including the perverting influence of commercial forces and the lack of good evidence to support many common practices and therapies. Also, many Canadians are obviously not satisfied with their interactions with conventional practitioners – which, it seems, are too brief, mechanical and impersonal. These issues need to be addressed.
But the response to the problems of conventional medicine should not lead us to the embrace of pseudoscience. On the contrary, it should push us toward better, independent and rigorously executed health care research. It should push us toward a science-informed approach for all therapies and preventative strategies.
As nicely summarized by well-known science advocate, Ben Goldacre, a flaw in aircraft design does not mean we should turn to magic carpets.
The Oxford University Press recently declared that “science” was the top word of 2013. I took this as a positive sign that we were collectively moving away from our embrace of pseudoscience. I hope that in 2014 science continues its ascension, particularly in the realm of health policy and in hallways of provincial and territorial health ministries.
Timothy Caulfield holds the Canada Research Chair in Health Law and Policy at the University of Alberta, is a Trudeau Fellow and is the author of The Cure for Everything: Untangling the Twisted Messages about Health, Fitness and Happiness (Penguin, 2012). Follow Tim on Twitter @CaulfieldTim