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.
The comments section is closed.
I know this article is old, but it is still wrong. For people with chronic health conditions but with no identifiable pathology, or none that conventional medicine is willing to look into, naturopathic doctors have been a lifeline.
My doctor gave me sleeping pills for insomnia. My naturopath advised me to quite drinking coffee. Guess which suggestion worked, was safer and had no side effects? Doctors are so quick to give pills that they barely even look at you. I think many more people die a year from conventional medicine since their methods are so much harsher. Just look at the opioid epidemic.
By the way, if you check out this link https://www.ccnm.edu/research/primary-research you can see that research is being done between naturopathic community and conventional medicine. Hopefully this will help to heal this silly (and frankly sexist) divide.
Mr Caulfield is not a medical doctor of any kind and has never participated in clinical trials of any kind so his opinion is just that, certainly not based in fact.
Forgive my frankness, butI respond to the aggressiveness of what i just read above: with all due respect a rather immature and limited view.
Science is so limited and so arrogant, should not be the axis upon which our health rests, On top of that, the now corrupt and decaying moral of allopathy/big pharma are obviously skewing research, using armies of hospital lawyers to cover up lethal mistakes and so on. Hospitals are il places offering fast food, fluorescent lighting and course, abusive nursing staff, chasing around arrogant whimsical doctors’ orders.
I ask, how often has this sort of thing happened to you?: …a doctor raced into your own hospital room, ignored the charts and said “so, are you ready for us to open up your left leg?”..”uh-it’s the right ;e.g.”
– “oh yeas, err, at any rate….’ Personally the last time I had an operation, I was told I’d receive several rounds of calming drugs in a 45 minute period before the operation. I sat wile listening to a nurse dicuss her vacations for 35 minutes than came in to my area. I reminded her about the drugs thing she looked at her instructions and said OMG okay here take all these right away, then rushed me into the pre-op area…not an unusual situation. I think. This is the culture of medicine, in general.
Such a mess, and all supported by our taxes.
Meanwhile the general level of care at a TCM, Massage, Ayurveda, or Homeopathic clinic is ten times better, with actual healing-feeling environments, long appointments, an interest in the full story of the patient and an understanding of how all these parts fit together – from heart, with humility. A knowing that much of what happens with healing is not linearly quantifiable nor controllable by man. Vast and profound, sacred things are at work that require a balance of compassion and insight, methodology and intuition to address. Sometimes a person isn’t supposed to get better. Mostly they do get better by us getting out of the way, with gentle support – it isn’t us doing it. These are things that only personal humility and training by yielding to thousands of year old lineages (and some personal meditation/devotional work can begin to uncover.
Naturopathy is similarly missing this, as allopathy is. But //naturopathy seems to have a fresher, broader brush to paint with. They could both learn from yoga, TCM , Ayurveda, and so on.
“science” and “Medicine” are in toddler stages, wit the self-absorbed nature of a pouty teen ager.
It’s a bit like why the governments and big business of the West have done to Africa and the East and what they have done to the native population in North America – ignore their wisdom, dehumanize them in our hearts, grab their resources, yank them from the hearings and safety they rely on, and force the West’s low-quality ways upun them, claiming it is infinitely better.
Yoga has eight limbs of study and practice – the postures is only one of them. What it knows about breath, ethics, mind-body health and an individual’s relationship with the cosmos is a hugely deeper and massive amount of information than a jargon-laden tunnel vision medical degree. It;s like comparing a lovingly prepared and organic homegrown meal to a frozen TV Dinner. And, yoga understand that these principles cannot be purely cognitively argued/memorized/imitated. It requires practices that open up the intuition, the heart and the body, to work with the mind in
“understanding” and applying healing. -a joint effort of assisting healer and client.
Yoga also has simple trainings to open up to the natural healing that is surging through our bodies, in the west, interrupted by poisonous and misinformed interventions. So yoga is one example of something science has not much understanding of.
Look to Taoism, Tibetan Medicine and all the others – there’s a diasporic canon of understanding that makes “science” and Western medicine look like a child, even if a bratty one!
Have a little respect for 5,000 years of loving and intelligent development! Stop protecting your little turf and learn to (truly) breathe – learn to listen. Give up the monopoly and take a back seat.
http://www.InAmongEverything.wordpress.com
Timothy Caulfield is hiding behind a wall of obliviousness and a bombardment of idiocies. I shared them with colleagues. None of them accepted to dignify them with a single comment
If evidence based medicine is as profit driven and power hungry as a few of the commenters suggest, then why wouldn’t it simply take any and all alternative therapies and treatments and offer them in their own practice? I suggest mainstream medicine does take those practices that have convincing data to support their inclusion into publically funded medicine while leaving the remainder for incredulous ripoff artists. There are many researchers who make their careers on testing therapies that exist outside of mainstream medicine precisely because doctors are constantly seeking to offer more and better treatments to patients.
I believe selling ineffective treatments and therapies (same or worse outcomes than placebo) to suffering and sometimes desperate people should be considered assault and fraud and dealt with under the law accordingly. Ignoring the harms of pseudoscience is a dangerous stance for society to take on an issue as important as the healthcare of our families and friends.
Effective and evidence based alternative medicine is just called medicine.
awesome article…. keep up the good work
Nailed it,
Naturopathic Doctors and alternative medicine saved my life. I went from a healthy 120lbs to 89lbs and dying of an intestinal issue (couldn’t walk, hair falling out, skin covered in rashes, chronic diarrhoea, etc) and the conventional medical doctors and specialists were stumped. They were going to remove my colon and put me on medication that has nasty side effects.
I said no….I had to try something different. And I’m so grateful that I listened to my intuition. I worked with a holistic nutritionist and homeopath who turned my health around within 2 weeks. I worked for 3 years with a naturopath, acupuncturist, and continued with a special diet (that the registered dietician was clueless about). My digestion, hormones, energy and overall health improved greatly with natural medicine.
One more thing (and it’s gross)…..when I initially became ill and had chronic diarrhoea and cramping I had 12 stool tests and blood tests done by my GP and they came back “normal”. I told this to the homeopath who gave me homeopathic parasite remedies. I filled the toilet with worms every day for 10 days. Then all my cramping and diarrhoea stopped and I started feeling better.
In my German community, who rely on homeopathy, I hear stories like this all the time, over the last 15 years. A lot of my neighbors are farmers and parasite infections are common. The O-T-C pin x remedy at the pharmacy doesn’t work. It doesn’t kill parasites it only paralyzes them and they often don’t get eliminated with a bowel movement.
If you haven’t had a terrible illness and resorted to alternative medicine to find out that it actually works then you shouldn’t speak about it. I’ve met hundreds of people who have had similar experiences as mine. How do you think we survived for thousands of years? How do you think indigenous populations continue to survive. Herbs!
nature pathic care herbs vitamins have there place here they work just as often or beter then main line practice just because you don’t under stand yet doesn’t mean a thing remember when you people drained blood out of when we wre sick remember when you didn’t wash your hands when you operated remember thylidamide remember smoking cant hurt you curing is being replace by maintaining staying sick cant turn in to a industry
Medicine is an Art not a science. Naturopathy is neither.
If people want to pay for “pseudoscience” then let them…no one is holding a gun to their heads to pay out of pocket for it. In a socialized medicine state like Canada it’s the only alternative short of going south of the border. Me thinks you complain too much considering MD’s have a differential advantage at attracting patients over ND’s…they don’ have to charge the patient anything for the visit. Also, there are not enough MD’s to go around…took me 18 months to find one after my MD moved to the States. I know a good handful of ND’s who are extremely science based and would make most MD’s look like bumbling idiots.
Creep must always be a concern, but embedded is usually more dangerous. When the overwhelming majority of treatment for Americans, and I assume Canadians, has degraded to be little more than drugs, one has to wonder what kind of evidence medicine is being based on.
Naturopathic medicine is not pseudo-science. You can treat the symptoms of autism with naturopathic medicine, it’s called the DAN! protocol.
I wouldn’t put the two in the same boat!
Tim,
The amount of misinformation and name calling in anything your write about Naturopathic Doctors upsets me.
First of all Naturopathic Doctors or Naturopathic Physicians (Not “Naturopaths”) are already a registered, self governing health profession under the health professions act. I suggest that your cursory overview of what ND’s are about was not enough and you should do your homework.
I am insulted that you suggest it is not possible to wear two different hats when sitting down with a patient, I do it all the time. For instance, I will first outline the evidence based treatments that have proven efficacy for a treatment (medications, exercise, lifestyle changes) and then I will also outline other treatment options that have limited evidence such as botanical remedies, certain types of diets, or perhaps certain physical therapies. I am very clear with patients as to what treatments have good evidence, which ones have refuting evidence, and which ones have no evidence. I also include the evidence in the risk benefit discussion so they can weight both the upside and downsides of these treatments when possible. I was taught that the practice of evidence based medicine takes into account scientific evidence as well as patient values; that’s what I do, and I think its what most of my colleagues do.
The generalizations and assumptions you make about anyone that is not an MD are embarrassing, you should stop this behaviour. If you are an equal opportunity skeptic, why are not going after every physio, MD, or psychologist, out there for practicing acupuncture, homeopathy, EMDR, thought field therapy, and other weak evidenced therapies as well? If you were truly equal opportunity I suspect you might not have anyone that wants to sit at the bar with you at the end of the day…that’s assuming anyone does right now.
I am fully aware that there are a lot of therapies out there that people are wasting their time and money on, and that these treatments are possibly causing harm. I also want these practices to stop, but I think a more inclusive and productive approach is needed if you want to move forward without alienating the very people that you are trying to help.
Dr Ryan Oughtred
Naturopathic Physician (Not Naturopath, not Homeopath)
Please provide a brief overview of the training required to become a naturopathic physician.
I agree with Timothy completely on this one. While there are definitely a lot of problems with science-based medicine, it is still the best bet. The fact that these practitioners believe in homeopathy, raises a lot of concerns. For those who think naturopathic medicine is credible, they can go to Science-Based Medicine, Respectful Insolence by Dr. David Gorski, a.k.a., ORAC, and check out the science. Even people who profess to believe in CAM, will always without fail, go to a doctor educated in the Western-based medical system for treatment. While I have to take some pharmaceuticals for my hypertension, I always work on changing my diet, getting more exercise, and to distress. All of this comes from science-based medicine. I think it is high time to challenge this foolishness and call this for what it should be called–quackery!!!!!!!!
re: “We should not forget that evolution is only a theory, as it has not been proven…but widely accepted.”
This statement confuses a scientific hypothesis with a scientific theory. Theories will never become law, and laws were never theories to begin with. Theories are worded explanations of a fact, while laws are simple mathematical equations. So laws are not theories that has been proven. Since there’s no math in evolution, there will never be a law of evolution.
Evolution has been proven. An obvious example is the evolution of bacterial resistance.
I don’t think naturopaths should be considered health care providers.
A few weeks ago the head of the College of Naturopathic Doctors of Alberta said that vaccines are a ‘grey area.’ The last thing we need are people who are considered health care providers sayings things like that, which are totally false. It is settled science: vaccines are safe and effective.
Now, no drug is every 100% safe and effective, but in terms of a risk-benefit ratio, the risks of serious adverse events due to vaccination are around one in a million, while they potentially benefit everyone who gets a vaccine.
The “theoretical” bases of naturopathy are ludicrous and DEMONSTRABLY false. For example, the idea that water has memory and can remember every molecule it has come in to contact with and thereby adopts the properties of every molecule it has contacted with is clearly false. If the “water-memory” hypothesis were correct, then every drop of water on earth would have the properties of any drug that ever existed, so long as at least one molecule of that drug came into contact with water (which is surely would). This is clearly absurd and demonstrably false. Also, since this hypothesis of naturopathy says that dilution increases the potency of the ‘water-memory’ effect, then even a drop of water should result in a fatal overdose of every drug ever produced.
I think those who like naturopathy are largely ignorant of the hypothetical ideas that serve as the foundation of naturopathy. I think they also generally like the idea of an approach to health care which emphasizes avoiding drug use because of the mistaken belief that ‘natural is always better.’
Police were called into the OICC last Thursday in Ottawa after the coroner attended to the death of a cancer patient who was treated with some i.v. therapy. It was reported by the Ottawa SUN on April 4th.
There is not much to add that has not been already said, however, this article reeks of bias to me. Bias against ways that have not had the time, money or support to be evidence-based. Tim’s major premise is that because they have not been proven, they are pseudo-science. We should not forget that evolution is only a theory, as it has not been proven…but widely accepted.
I am a user of homepathic medicine. I have seen it work. I have used it as our first line of defense in my family since my daughter is born, for non-threatening illnesses. She has, what I consider, an incredibly strong immune system thanks to this. I can’t explain it, nor do I need to. I feel it works. But that doesn’t make it pseudo-science because we can’t explain it.
It’s too bad that modern medicine feels threatened by other complementary and alternative medicines. Tim mentioned one death of homeopathy, but I think it would be much easier to find how many deaths were due to negligence and malpractice. Should we through modern medicine under the bus then? No. I believe there is a place for everyone at the table. This mentality of and/or is only polarizing the situation further, and is demeaning for all those other professions, who are treated with respect in many European countries.
Remember…we are unable to explain all science either. Take a look at metaphysics as one example. We know it’s happening, but can’t explain why. Doesn’t make it less true.
I’ll keep using alternative forms of therapy, knowing they aren’t reimbursed by the health system, not because I believe only in alternative therapies, but because they are a great complement to antibiotics, and other conventions of modern medicine that treat the manifestation of the problem and not the underlying symptoms.
Speaking as a naturopathic doctor and someone who has been active in clinical research and in caring for patients over the past ten years, I emphatically disagree with the tone and content of this opinion piece delivered from Mr. Caulfield.
Naturopathic Doctors (NDs) receive their training during an intensive full time four year post graduate program delivered in one of seven colleges accredited by a council recognized by the US federal government. The two Canadian Colleges, the Canadian College of Naturopathic Medicine (CCNM), and Boucher Institute of Naturopathic Medicine (BINM) are located in Toronto and Vancouver respectively. For anyone with serious questions about the naturopathic medical profession, I urge you to review the curriculum at one of these colleges to see the basis of training NDs have in order to be qualified and licensed to practice. This includes a series of cumulative examinations (knowledge based and practical) whose scope is equal to the medical licensing exams that our MD colleagues go through.
Mr. Caulfield rightly points out that NDs can speak the language of science as it is applied through clinical research and in our understanding of physiology and pharmacy. However, he criticizes this as a ‘two hat fallacy’. The fundamental problem with Mr. Caulfield’s argument lies in the premise that there are only two options available, science and pseudo-science, right and wrong. What is missed is that in the practice of medicine, most often there is no single therapeutic solution available but rather a mix of approaches that can help and which differ depending on context and the history each person presents with. Indeed some of the fundamentals to good health: stress reduction, exercise, and nutrition provide the backbone of naturopathic practice. Rigorous clinical research on the system of naturopathic medicine is still limited, yet research to date does support the hypothesis that we provide added value to patients particularly with chronic conditions. A recent publication in the Canadian Medical Association Journal (CMAJ) attests to this. The study, using a randomized pragmatic clinical trial design found that care delivered by naturopathic doctors provided in addition to conventional care significantly reduced the risk of cardiovascular disease and incidence of metabolic syndrome. The study is published and freely available for review. http://www.ncbi.nlm.nih.gov/pubmed/23630244
The concept that medicine can be classified as either science or pseudo-science is simplistic at best and completely misses the point of medical practice. Medicine is an art and a practice and where possible scientific principles are used to test the ability of therapies to have benefit and limit harm. While excellent at establishing causality for a tightly prescribed intervention there are serious limitations to the typical randomized controlled trial (RCT) when it comes to real practice and particularly when therapies are complex and individualized, based on treating the person and not a population as a whole. RCTs are most effective when used to test highly controllable medications, really a design suited most to the pharmaceutical industry.
An exploration of the research available in the medical literature will quickly disillusion anyone to the fact that there is no evidence on which to base naturopathic practice. Mr. Caulfield referenced the website for the Canadian College of Naturopathic Medicine to support his claims, to look further and explore the research section of the website he would have come across a series of peer reviewed publications outlining some the work the department and college faculty have done. http://www.ccnm.edu/research_abstracts
The idea that conventional Western medicine is the only true harbor for evidence based medicine and that all practices from this discipline are truly evidence based is simply not true and nor should it be. Well-applied evidence-based medicine judiciously includes available evidence with clinical experience. What NDs provide is an inclusive way of perceiving health and providing treatment that allows for individualized care for our patients while respecting informed consent, real choice, and an interaction that educates people on how to better care for themselves.
I encourage an open, skeptical approach to medicine (conventional and complementary) without approaching the idea from a stark ‘with us or against us’ attitude that is too easily promoted. Negative rhetoric does little to explore the issue in any depth and making contrasts that relegate medicine to a mechanistic scientific approach versus a magical holistic approach serve little purpose beyond the inflammatory. Medicine and human health in whatever it’s form is rather difficult to fully quantify and options for care that are rational, safe and varied provide a more robust and versatile system that can only benefit the health of Canadians. The move by provincial governments to regulate the profession of naturopathic medicine increases public assurance that the care they receive from NDs is provided by someone with the training to recognize and deal with serious health conditions and to know when to refer effectively when something is beyond their scope.
It is surprising and unfortunate to see the tragedy in Alberta used by Mr. Caulfield to support his argument and create fear when regulations and perhaps a more supportive environment for integration of care could perhaps reduce the likelihood for such a tragedy. I greatly respect the work that my MD colleagues do and am encouraged by an increasingly respectful and open attitude that GPs and specialists have when it comes to naturopathic medicine and the value NDs can provide in supporting people’s health. A stronger regulatory environment can only strengthen public safety and trust and ultimately a more effective collaboration between naturopathic and conventional doctors that is in such demand.
The movement towards integrative medicine is one that is progressing and is truly a patient led phenomenon. This is perhaps best demonstrated in the field of integrative oncology which has brought together clinicians of all stripes that recognize the need for a more inclusive approach to care for people living with cancer. Demand for this level of care is growing and I hope we can use the energy of this debate to help the process work for the people we are trying to serve. Rather than raise walls and entrench biases, we need to work towards improving a health care system that is stumbling and moving rapidly towards unsustainability. The rise of naturopathic medicine is based on informed choice made by people every day. In fact, this offers an opportunity for engagement towards a more proactive approach to health care that is so desperately needed.
Dugald Seely, ND, MSc, FABNO
Director, Research & Clinical Epidemiology; Canadian College of Naturopathic Medicine
Executive Director; Ottawa Integrative Cancer Centre
What happens at an “integrative cancer centre”?
Dr. Raksub,
There are numerous examples of integrative programs/centres across N.A. . In the US, there are some very well known institutions like Dana Farber in Boston, Memorial Sloan Kettering in New York and MD Anderson in Texas which have integrative programs. Other even more integrated examples in the States include the Block Centre in Chicago and the Cancer Treatment Centers of America.
In Canada, there are two principal places providing and researching integrative cancer care, these include InspireHealth in BC which now has funding from the BC government and the Ottawa Integrative Cancer Centre (OICC) in Ottawa where i work.
Each of these integrative centres have their own unique model, however an underlying common thread is patient focused whole person care where a number of modalities and disciplines are used to help treat the whole person hopefully in a coordinated way. Within the field of integrative oncology, complementary medicine is recognized as adding real value to the patient’s experience and the ability to support health and quality of life. Examples of this include naturopathic medicine, nutrition, acupuncture, yoga therapy, exercise, massage therapy, physiotherapy, and counseling.
Another major goal within an integrative cancer setting is to enhance communication between all health care practitioners involved in patient care, this includes both complementary and conventional so as to improve care overall and reduce patient’s anxiety and sense of being torn between two disparate types of medicine. Ideally integrative oncology brings what is best from complementary medicine to the table, eventually moving towards less of a division recognizing issues of safety with an emphasis of potential for negative therapeutic interactions and relevant contraindications.
If you are interested in more information on the OICC, this can be best found on our website at http://www.oicc.ca . I recommend watching the video on the home page in particular.
Dugald Seely, ND, MSc, FABNO
I’d very much like to hear your stance on homeopathy and detoxification, two practices that are, as far as I can tell by looking at a number local practitioner’s websites, in every naturopathic doctors catalogue of things that they will sell you.
This is all about greed.
I am extremely critical of the practice of naturopathy, and entirely dismissive of the quackery of homeopathy.
The main issue, however, is not that naturopaths work their sorcery on unsuspecting, foolish, or desperate patients. It is that naturopaths want to be granted the privilege of using allopathic, scientifically valid medicine without having adequate training to do so, which seems to be motivated by greed.
In other words, naturopaths want to stop practicing naturopathy and start practicing the medicine they so deem themselves an alternative to, all in the name of the almighty dollar.
Medical diagnosis and treatment is not easy, and can certainly cause a massive amount of harm if not used properly. Proper tutelage in its use takes anywhere from six to twelve years. Naturopathy school is not proper tutelage.
Furthermore, the academic standards of naturopathy schools are far less stringent than that of medical school. Less talented, less motivated and less intelligent people can be admitted into naturopathy. To allow them to practice true medicine is a hazard to society!
This is a wonderfully pithy critique of the pseudoscience of naturopathy, homeopathy and the like. Practitioners in these fields deceive themselves and their patients with factually unsupported therapies promoted with fallacious claims that their “natural” treatments are superior to conventional, presumably unnatural, approaches. Anything more than casual scrutiny of these claims should be enough to discredit them. I urge our goverments to stop pandering to those making these baseless claims. These approaches are not harmless. Let’s put patient safety ahead of politics.
Tim Caulfield brings up an important point, in that no medical profession should allow pseudoscience to creep into the practice. As a board certified MD, in internal medicine who has grown my practice into a science based integrative, Functional Medicine practice, I have worked with many MD’s who have NO clue of how to make a patient healthy, i.e. facilitate self-healing in the body by making dietary changes, lifestyle changes and using directed nutritional/nutriceutical supplement recommendations. In addition I have worked with very skilled ND’s who have helped many patients get healthy. Yes, there are always fringe ND’s who are way out there when it comes to belief systems and practices. Not that long ago, traditional medicine did not believe in “leaky gut” which is now being recognized by mainstream medicine or the concept of blood type affecting one’s health because of the science of glycobiology as it relates to the immune system. Peter D’Adamo, ND first proposed The idea of the Blood Type Diet years ago, and so many mainstream MD’s (including myself) looked askance at this concept as it did not fit into our preconceived mental paradigm. Today we now know that Dr. D’Adamo’s Blood Type DIet is based in hard science and it can help in a number of medical conditions. All too often I see Canadians crossing the border to seek medical help with me, because their Canadian doctors throw their collective hands up in the air because they don’t know what is going on and can’t help simply using ONLY a pharmacologic approach. I have successfully treated many patients using approaches that a traditionally trained doctor might look upon as “pseudoscience” medicine. As a doctor in the trenches taking care of sick people, I want as many tools in my black bag as possible to help people. This concept is not black magic, it is actually good medicine, so long as the doctor using these tools takes into account the risk/benefit ratio of the treatment(s), and knows when to use an elephant gun (toxic pharmacologic medicine) or use a feather (homeopathy, vitamins, etc) to help a sick patient regain health. The practice of medicine is both an art and a science. As for an “individual’s inherent self-healing mechanisms.” , this is not rhetoric, it is a very real phenomenon. Or as Voltaire said, “God heals the patient and the physician collects the fee” and “Doctors pour drugs of which they know little, to cure diseases of which they know less, into human beings of whom they know nothing”
“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. ”
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What are your sociopolitical assumptions and evaluations behind this statement? Do commercial forces (health provision or more indirect influences) affect conventional Canadian Health Care policy and provision decisions? How does that (often policy weighted) decision process play out in our real world? Try including education of professionals, politicians, and those students who are aiming for either keeping in mind what can change to enhance the evidence. How is “evidence based” defined differently in the political & policy realm as opposed to an academic health centre?
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“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. ”
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So what is the scientific clinical evidence to back up this statement? What about the socio-political evidence? How do you propose to “address” this concept and move what we know about health and wellbeing in relation to the body of good scientific *medical* care and maybe *health* evidence, move it from what we know to what we **all** do, and how the doing can also stay accountably current and effective and in a single patient as well as their community?
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“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.”
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Maybe this is an opportunity to scientifically evaluate changes in health and wellbeing (OECD, etc) in the two approaches and examine the ways conventional Health Care and the so-called complimentary medicine is taught, regulated and protected by each college and Provincial and federal legislation? A more integrated systems oriented evaluation so as to **synthesize evidence** on how to keep and get folks in an overall state of well-being and health according to **all** the the current and emerging evidence; socio-politically, medically, and systematically.
If I’ve understood correctly, Mr. Caulfield takes issue with allowing naturopathy to become self-regulated and for practitioners to have expanded rights because 1) this would put patients at risk, and 2) it would would displace the, supposedly, fundamental role of science in the Canadian health care system.
I can’t speak to the risks of naturopathy; that’s beyond my area of expertise. I can certainly speak to the risks associated with end-of-life medical care in hospital. Through the course of doing so, I’d also like to challenge the dichotomy the author drew between a scientific worldview and a philosophical framework, implying that medicine and medical practitioners are somehow safe-housed from ideology, culture, and environment.
From my vantage point, in sanctioning and regulating what is “appropriate” medical treatment, the state provides a basis upon which the physician and patient alike can be punished by law if that boundary is breached. What is often missed in this binary is how terminally ill patients can be punished irrespective of whether they actually breach the law. This punishment comes in the form of being held hostage by an illness, prognosis, and treatment that contravene a person’s core values. In other words, our bureaucratic structures and systems of regulation not only serve as a form of social control, they also define the parameters of human life (and by virtue of community values – i.e. what the dominant culture wants to preserve and what they want to legitimate and validate by “treating,” if not “curing.”) Presently, we bear witness to the state pedaling the idea that life-sustaining interventions and palliative care are morally obligatory and standard courses of treatment that express due care and respect for the value of human life and health in terminally ill patients. However well-meaning, experience and testimony show that these seemingly morally sound decisions and standard courses of treatment can actually serve as the foundation for continuing degradation, suffering, and indignity of those who stand to “benefit” from them.
Finally, I’d also like to note that we’re living in a culture characterized by access to information, proactive patients, and thereby many lenses through which those who live in liberal-democratic nations look through when regarding their prognosis and treatment options. I suspect Mr. Caulfield’s Op-Ed would benefit from looking through another lens.
I was shocked to read in the Winnipeg Free Press this person’s rather dogmatic diatribe against naturopaths and their trade. I hold no brief for naturopaths, but a few fundamental questions have to be asked of this perso. Among them are:
1. What exactly are his qualifications to even comment on naturopaths?
2. Why are there no specifics offered, but only generalizations?
3. As he seems preoccupied with the word pseudoscience, does he hold the same narrow views abiut chiropractic, accupuncture, accupressure, healing touch and other oriental or homeopathic approaches? They all seem to work though none can be scientifically explained.
Charles Phelan
Winnipeg
Why do the least educated speak the loudest?
I am not an MD nor an ND, but I am a worried citizen when slanderous articles such as this are published. I can only hope that someone at CCNM OAND or CNDA (or any of the boards for that mater) stand up and puts you in your place sir. As a member of the faculty of law and self proclaimed scholar you must assume allegations and reference to a specific school will not go unnoticed. I mean, really, defamation suit anyone? I feel sorry for the schools you attended that have to call you ‘Alumni’.
These doctors are working for the greater good, ‘alternative’ is simply to have the option. Western medicine absolutely has its place, in 2000 I had my appendix removed, and being the son in-law of pharmacists modern drugs also have their appropriate time of use. 2 years ago I had a persistent cough, I sought the advice of an MD, who qualified for a fraction of a moment prescribed a steroid that did absolutely nothing (but I’ve heard, science has proven steroids are phenomenal for the body).
Enough about me, back to you. I propose that you have a healthy debate with a naturopath. I would also like to see YOUR research that has brought you to this conclusion. One more thing, how dare you bring an Alberta family into your misguided article. Again, draw your conclusion on facts. I read the article, and our law indicates innocent until proven guilty by a jury of her peers which has not happened, yet you are convicting. SHAME ON YOU. Beyond that there was no evidence that a naturopath was treating the child or family. With a few clicks of my mouse, I could produce thousands of articles of malpractice by “Science Doctors”.
Naturopaths in my view, have been too patient, allowing bullies like you to speak freely, slander, criticize, and misguide those who do not question loudest speaker. This is probably the calm environments in which they live their lives, free of collusion. I have not met a Naturopath who works for the pay cheque, they work and spread their KNOWLEDGE for the good of their patients.
Tim, I fear that your place in this world is a union rep and you missed your calling. I am not sure what strings you need to pull to have an unfounded article such as this published. Perhaps it was a slow week at the star? To inhabit a human body is science. I will go ahead and make the assumption the timing of your article is based on naturopaths across the country rising up for prescribing rights, excluding B.C. (they already have that right). And how dare they curb the kick backs of Pharma from the MD’s, because I am sure the ND’s will not be receiving them.
In your article you mentioned that there are contraindications between Herbal and Pharma. Please, could you tell me what these are? Considering herbal plant based medications are natural, should a draw the conclusion that the phrama brand is bad for my health?
Some of the smartest humans in the world once thought the world was flat!
Yours truly,
Jordan
The properly prescribed, “evidence-based”, conventional medical care you speak so highly of in terms of safety relative to alternative medical practices accounts for approximately 1/6 of annual deaths in the United States each year. The last annual report I saw showed ZERO deaths from all forms of nutritional supplements consumed by the same US public in 2008, including vitamins, minerals, amino acids, and herbal medicines. You say this is not a turf war or fearful resistance by a medical community worried about its own popularity, but instead a question and concern about patient safety. How could ANY LOGICAL PERSON argue that conventional medicine is safer?
The “war on cancer” by the conventional medical community is currently being lost as they utilize a litany of unproven, unsafe, barbaric treatment methods to treat a wholly misunderstood health condition.
The conventional treatment of diabetes and heart disease is pathetic at best and only to be spoken of highly for the fact that it can slightly prolong the (typically drugged, side-effect riddled, miserable) lives of the patients who stick to conventional treatment only.
You call such approaches “evidence-based”? Evidence of what? Ineffectiveness? Blind faith in a broken system?
You call only for treatment that is research based? Have you read this? http://articles.latimes.com/2013/oct/27/business/la-fi-hiltzik-20131027
I can only conclude one thing from your article. You have not had a loved one faced with a chronic disease for which conventional medicine had no other answer save pills that mask symptoms as the condition itself continues to progress, and/or procedures that try to burn or cut out the problem area, leading to their own severe side effects and/or a resurfacing of the same problem somewhere else.
Properly prescribed, thorough, responsible, naturopathic medical treatments could result in side effect-free cures in at least some of these types of diseases. Conventional medicine occasionally results in “cures” as well. The only difference is that the cures brought about via naturopathic medical care happen BECAUSE of the treatments prescribed, not IN SPITE of them.
Try this on for size Mr. Science: http://www.youtube.com/watch?v=VIIQVll7DYY
I agree the Cochrane Collaboration provides a very useful resource for synthesizing our collective knowledge on specific health issues. The Cochrane Library contains thousands of systematic reviews with the participation of over 13,000 consumers, policy makers, clinicians and researchers involved in the various review teams which undertake to rigorously and systematically evaluate the available evidence. (1) Most Cochrane review groups target specific clinical areas whereas some also review specific interventions intended to improve health care delivery and health care systems. It would be useful to bring some of the same discipline associated with the Cochrane Collaboration to some of the specific health and wellness issues and perspectives identified in this debate to help evaluate and synthesize the evidence and claims for consumers, policy makers, clinicians and researchers.
(1) Grimshaw, J. M., Santesso, N., Cumpston, M., Mayhew, A. and McGowan, J. (2006), Knowledge for knowledge translation: The role of the Cochrane Collaboration. J. Contin. Educ. Health Prof., 26: 55–62. doi: 10.1002/chp.51
I wish to express my support for Timothy Caulfield’s December 16 article on the danger of naturopathy. Some of the expression intended to ridicule naturopathy in the piece are so over-the-top that they may reduce the credibility of the article for some readers, but I believe that such statements are justifiable.
My late wife died of metastatic bone cancer eleven years ago, before she reached the age of 60. What follows is an account of our involvement with naturopathy. It was written a few months after her death, and revised today to remove names and improve clarity.
Desperate to try anything that might postpone her death, we accepted the recommendation of a friend who had had decided to forego “conventional” treatment and put all her confidence in naturopathy. We continued conventional treatment, but tried naturopathy as well. At our first appointment, I brazenly asked the naturopath if I could be present during his diagnostic procedure. He agreed, and I witnessed him performing bizarre swirling motions over my wife’s body; I listened to his comments about auras and force fields, and the need to get her system into balance. He prescribed a course of dietary precautions and “remedies” (he did make the required statement that these are not approved as medicines), and spoke with great confidence about the value of his treatment for persons suffering from cancer. The cost of the remedies, which of course were not covered by our drug insurance, was usually well over $1000 at each visit. During later visits, he declared her system to be in “excellent balance,” and modified the remedies accordingly. Our confidence was not enhanced when my wife’s friend died, but we reminded ourselves that she had refused chemotherapy, and we wanted to believe that the naturopathic remedies could be complementing the conventional treatment, and were not likely doing any harm. Our GP recommended against naturopathy, but agreed that it probably wasn’t harmful. The worst moment during the course of the naturopathic “treatment” came when my wife strode out of one appointment with great energy in her eyes, thumbs up, declaring, “He says that my body is entirely free of cancer.” My face must have betrayed my horror, because I knew that it wasn’t true. Doubtless, the tactic was to support healing by offering optimistic reports (our GP used the same strategy, but made statements that were credible), but I found that declaration to be particularly cruel. In any case, we continued naturopathic treatment until the end of her life, at a total expense of more than $30,000. When we discussed the cost, I always said, “You’re worth it, and I’m willing to pay just for the hope that it may work.” Perhaps the treatment and the encouragement did help to extend her life somewhat. We will never know. I do know that I won’t be pursuing naturopathic treatment when my turn comes to face debilitating disease.
Dear sir,
I’m truly sorry to hear of the experience you and wife had in this case and for your loss. As someone who sees cancer patients daily, your post is deeply disturbing to me. So much of the experience you’ve had is highly questionable and perhaps most is the faith based claim made that your wife was cancer free without any recourse to diagnostic imaging.
I can’t help but wonder if the naturopath in question was trained at one of the accredited colleges; I.e. the Canadian College of Naturopathic Medicine or Boucher Institute (a requirement for regulation in those provinces that do regulate the profession). If so, and there are regulations in your province for naturopathic medicine (see http://www.cand.ca) , then i think cause for complaint to the regulatory board is more than justified. If not, then it’s possible that you were not seeing a naturopathic doctor but someone with any possible level of education and no means of ensuring their qualifications. This situation for example is rampant in Quebec where there are no regulations and with all kinds of practitioners who have varying levels of education calling themselves naturopaths.
I can’t but help to hope the situtation is the latter (i.e. case of being a non-ND) but if not, then i sincerely apologize on behalf of all NDs for your experience and hope you carry the situation forward more formally. I hope you dont find this disrespectful in any way, but to me this confirms the need for regulations and a process whereby the public can take action when mistreated.
Dugald Seely, ND, MSc, FABNO
Ottawa Integrative Cancer Centre
Thought it may be useful to look at the definition of ‘science’. Maybe we are collectively reflecting our own backgrounds, training and philosophical values in our various positions. The net result is confusion – particularly for those seeking solutions to very real health and wellness concerns.
Defintiion: Science (from Latin scientia, meaning “knowledge”[1]) is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe.[2][3] In an older and closely related meaning, “science” also refers to a body of knowledge itself, of the type that can be rationally explained and reliably applied. A practitioner of science is known as a scientist.
Since classical antiquity, science as a type of knowledge has been closely linked to philosophy. In the early modern period the words “science” and “philosophy of nature” were sometimes used interchangeably.[4] By the 17th century, natural philosophy (which is today called “natural science”) was considered a separate branch of philosophy.[5]
In modern usage, “science” most often refers to a way of pursuing knowledge, not only the knowledge itself. It is also often restricted to those branches of study that seek to explain the phenomena of the material universe.[6] In the 17th and 18th centuries scientists increasingly sought to formulate knowledge in terms of laws of nature such as Newton’s laws of motion. And over the course of the 19th century, the word “science” became increasingly associated with the scientific method itself, as a disciplined way to study the natural world, including physics, chemistry, geology and biology. It is in the 19th century also that the term scientist was created by the naturalist-theologian William Whewell to distinguish those who sought knowledge on nature from those who sought other types of knowledge.[7]
However, “science” has also continued to be used in a broad sense to denote reliable and teachable knowledge about a topic, as reflected in modern terms like library science or computer science. This is also reflected in the names of some areas of academic study such as “social science” or “political science”.
Reference for the definition: Wikipedia
Let’s be frank. Tim. Pseudoscience is putting 4 or 5 pharmaceutical products into an unhealthy system and assuming they will work out to the patient’s advantage, while there is no actual data on the real world consequences. Pseudoscience is allowing drug companies to conduct research and write the journal articles on their own products. http://ethicalnag.org/2009/11/09/nejm-editor/ Pseudoscience is believing you are right without testing your assumptions, and calling that science.
The claims of this writer are nothing more than a conceit. He is defending a system that has been opposed to change (often brutally opposed to change) throughout its existence. And if you put the track record of harm done by Naturopathic doctors up against the harm done by conventional doctors, the evidence is clear which is the more harmful. The facts speak for themselves. If his concern is that someone will delay proper treatment because of bad information, the fact is that this happens in all medical systems. That’s why it’s called ‘practicing medicine.’ Nobody’s perfect.
This author seeks to handily dismiss the failings of conventional medicine with a hint of regret, then wave them away while amplifying the shortcomings of a competing system of medicine in order to justify the conceit.
I agree with him about this: Natural medicine is not always science based. But neither is conventional medicine. The writer of the op-ed is projecting the failings of the system he defends onto the system he seeks to undermine. I wouldn’t expect him to see that or be able to change his mind, because he clearly does not approach the issue as a scientist, though he claims to be championing science. Instead, he is blinded by his cognitive biases and blind spots, and has become the pot calling the kettle black.
The real issue here isn’t science, which conventional medicine holds no special claim to, but instead, freedom of choice. Should people have the right to choose the kind of health care they want to receive? Or should that choice be made for them by a near monopoly pretending to be a benevolent big brother while feeding profits to a few at the expense of the many?
In the USA, naturopathic medical schools are recognized and accredited by the Department of Education through the Council on Naturopathic Medical Education. The professionalism of naturopaths can no longer be denied or easily dismissed, so this is their best line of defense.
In a time of doctor shortages and a bloated and inefficient disease care system that comes with extravagant cost while doing little to advance human health (unless you call keeping people alive and suffering for longer life spans ‘human health’), at a time when nature itself is increasingly under assault by private industry regardless of impact on human health, naturopathic doctors can be a valuable resource for citizens of Ontario. Please don’t let his misleading argument stand in the way of doing what is best for Ontario, who should have the right to choose a better way.
Sorry for posting it twice in the same comment, I’m on vacation! 2nd half is edited and includes a link on the loss of credibility in scientific journal articles, thanks to the influence of the pharmaceutical industry.
Hi Richard,
Thanks for your comment – I’ve removed the duplication to make it more readable.
Best,
Jeremy Petch
Obviously you do to know much about science. Your definition of what is science is deeply flawed, as it is limited. Science includes experimentation as much as it includes mathematics and physics. Most medicine is not science based anyway as it is narrowly defined. What works works regardless of how you categorize and label it.
As Einstein said: “Not everything that counts can be counted, and not everything that can be counted counts”
This sums it up. Do some research and reading, and actually learn about wht science is, what health is versus disease.
Unfortunately he confused homeopathy which is poorly supported by evidence with naturopathy which is well supported by evidence. As chair in health law and policy he should know better.
Michael, the Canadian College of Naturopathic Medicine lists six branches of treatment central to the Naturopathic approach (http://www.ccnm.edu/about_ccnm/about_ccnm):
acupuncture/Asian medicine
botanical medicine
physical medicine (massage, hydrotherapy, etc.)
clinical nutrition
homeopathic medicine
lifestyle counselling
… and the CMA speciality profile list includes plastic surgery among emergency medicine and medical oncology. We know there is a difference, whether it be ‘speciality profile’ or ‘branch of treatment’, and that the terms shouldn’t be used interchangeably. I agree with Michael and am disappointed that Mr. Caulfield chose to disregard the fact that they are different.
Or perhaps he just didn’t notice the difference, which happens in conventional medical practice more than it should (e.g. medication errors). I agree with the comments made by R. Kirschner, particularly regarding the conceit of the author.
Thanks for a great column. This needs saying, and saying often: but, as the comments show, it won’t convince those who believe in the powers of integrated/ alternative/ complementary therapies, because theirs is a faith-based conviction. Also a timely commentary, with the publication of the editorial “Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements”, Ann Intern Med. 2013;159(12):850-851.
Looking for proof of your starting assumption is not science. Your reverence for conventional medicine shows that you also have a faith based conviction.
I only hope the naturopaths will stick to the treatments they give to other people when they themselves get sick.
Interesting that someone who obviously thinks that he possesses a “scientific worldview” can be so unscientific in substituting opinions for facts. It also appears that Mr. Caulfield is attempting to make it appear that his opinions are those of the Ontario Medical Association, yet I see no evidence that he has credentials for membership (let alone as appointed spokesperson).
Medical ethicists in mainstream medical journals are increasingly questioning the veracity and scope of corporate sponsored drug and medical device trials. All readers need do is Google “health technology assessments” to find that all is not rosy in mainstream medicineland — less than 50% of current treatments are considered “effective”. Regulation is not preventing the estimated 35,000 deaths that occur annually in Canada from prescription drugs and medical error. Perhaps attempting to libel and lampoon Naturopaths using examples of non-drug based treatments that may or may not be used and falsely claiming that there is no research supporting these therapies etc. makes him feel more qualified to comment than those who actually take responsibility for patient outcomes.
What Mr. Caulfield is promoting with his “scientific worldview” is a philosophy most of us classify as Scientism. It’s vitriolic, narrow-minded, and relies entirely on perception.
Yes. Damn that scientism! Why should we rely on science to treat illnesses? Who says we shouldn’t use made up interventions to treat disease?
Scientism! What a narrow worldview!
Scientism is not science, it’s philosophy. And it looks like you’ve got a good dose of it.
This is the worst journalistic effort and badly researched article by a purported Health ethicist. Irresponsible at best.
%featured%Citizens will make up their mind without your consent.
Integrative medicine is here to stay, like it, or not.%featured%
I see you will be opting for the magic carpet route. Very bold.
Yep. A sucker is born every minute and there are enough of those around for these “naturopathic doctors” to suck dry.
One of the other issues which the author touched on, but didn’t fully go into, is that of accountability. As the author mentioned, a seven year old boy in Calgary lost his life due to these complementary and alternative medicine As an MD, if I assessed the child and the same outcome occurred I would be in under investigation with the College and potentially liable for a civil lawsuit, regardless of whether or not an error was made on my part. However, instead we have a mother (who in all likelihood meant the best for her son) being charged while the “professional” who gave her medical advice is free to cause the same harm to someone else.
Accountability is a key part of medicine which is lacking in the alternative and complementary medicine. If I do a history, physical or investigation of some sort I am obliged to follow this through to the end whether this requires extra reading, PubMed searching or a referral to a specialized colleague. Even if I can’t nail down a diagnosis, I make sure to rule out all the “red flags” and possible diagnoses to ensure that I’m not going to cause any morbidity or mortality to the patient. Unfortunately I just don’t see the same level of accountability with the alternative medicine crowd.
A seven year old boy in Calgary lost his life because his mother mistakenly believed he had the flu. She did not take him to any health care provider.
The establishment of a College of Naturopathy provides the same public accountability as the College of Physicians and Surgeons. Why would you be against it, unless you’re of the opinion (as many are) that the College of Physicians and Surgeons is more of a CYA organization.
I disagree with your statement that you would be under any sort of investigation unless a complaint was made against you and if you were following the guidelines of the College and your medical association it would be futile for a patient to launch a civil lawsuit.
You might also want to investigate why malpractice insurance for non-mainstream medical practitioners is so much lower than it is for drug-based medicine practitioners… probably has something to do with the fact that it doesn’t kill people or land them in Emerg. with adverse reactions.
Dear Mr. Caulfield: Congratulations on a courageous and excellent column. It reminds me of the warnings issued by Carl Sagan in his 1995 book, “The Demon-Haunted World: Science as a candle in the dark.” His words ring even truer today: “I worry that, especially as the Millennium edges nearer, pseudo-science and superstition will seem year by year more tempting, the siren song of unreason more sonorous and attractive. Where have we heard it before? Whenever our ethnic or national prejudices are aroused, in times of scarcity, during challenges to national self-esteem or nerve, when we agonize about our diminished cosmic place and purpose, or when fanaticism
is bubbling up around us – then, habits of thought familiar from ages past reach for the controls. The candle flame gutters. Its little pool of light trembles. Darkness gathers. The demons begin to stir.” You, and Sagan, have stirred them and they do not like it. You will be vilified and attacked. The quackyologists and their adherents will be apoplectic. I especially enjoyed the comment you attributed to Ben Goldacre regarding magic carpets. %featured%As as a friend of mine said, “When I have to fly somewhere, I always hope the pilot is trained in “traditional” aeronautics rather than “alternative” aeronautics. I am more likely to arrive at my destination with the former.”%featured%
Equating aeronautics to Western medicine is “illogical, Captain”. I assume you are referring to surgery when you make this comparison. As more and more hospitals close or consolidate in large urban centres, however, the role of the hospital is changing to be focussed on emergency and acute care. What about all the other aspects of healthcare which do not depend on expensive diagnostics and surgical procedures? Western medicine has accomplished a great deal; however, it has been concerned with sickness, rather than with health. Science begins with scepticism, and that also needs to be applied to the medical establishment and the private health insurance industry that feeds of it.
Great insight!
I had to double-check the date of this website, for these comments sound an awful-lot-like the scare-mongers of the 1960’s-70’s, before naturopathy was mainstream. Western medicine used to be the only avenue for a patient and it came up woefully short. People wanted alternative medicine and got it. Mostly everyone who uses alternative medicine knows it’s alternative – it is complimentary to, not instead of, western medicine. Many people have been cured of ailments because of the holistic nature of naturopathy, instead of just waiting for the band-aid to be applied by western medicine. While I will always agree to regulations of any health-practice, let’s not throw out the baby with the bathwater…
Probably because there are things worth being scared about. If you read the draft regulations, you will see that naturopaths are asking to be allowed to prescribe and compound (ie. mix themselves) IV potassium chloride. Potassium chloride is one of the deadliest chemical compounds we have. It is so deadly that it is the poison of choice for US states who execute their prisoners by lethal injection: http://en.wikipedia.org/wiki/Lethal_injection
%featured%Self-regulation is about protecting the public. Clearly Ontario’s naturopaths have yet to grasp this. They are not ready, and will probably never be ready, for self-regulation. Time to dissolve the transitional council.%featured%
Jill I have to disagree. The majority of advertising I see around complementary and alternative medicine is around being an “alternative” to conventional medicine. For example, look at “thermal breast scans” which have not been validated whatsoever. I have several patients who are not undergoing regular screening as they feel protected by the “thermal scans.” If you take a good look at these thermal scans they describe themselves as a “natural” and “safe radiation free” screening method. Seems to me that these folks are indeed offering “complete alternatives” to conventional medicine.
Furthermore, your description seems to completely disregard the profession of family medicine. A significant portion of my day, and each patient encounter, is spent on preventative medicine. The issue is that the “prevention” and “holistic” advice of most naturopaths is not based in the least bit of science. I am grateful when a patient comes back on a healthier diet that their naturopath recommended. I am not so grateful when they come back saying they require this or that vitamin test because their naturopath ordered it and then refuse to take a statin (even if they have a very high risk of ACS) because their naturopath said they can avoid MIs completely with diet and exercise.
Allowing naturopaths to prescribe and order tests simply legitimizes them in a laypersons eye. This is both dangerous and irresponsible as naturopaths are not trained to manage potentially dangerous situations. On the contrary, every physician, regardless of the current specialty has at least some emergency experience and knows of the red flags to look for.
One such example is a patient I saw with multiple co-morbidities and some abdominal gas. Of all the the chronic issues they had (DMT2, HTN, etc.) the gas issues would cause them less morbidity in the end. However, DMT2 and HTN rarely cause symptoms. Gas is symptomatic and uncomfortable. They saw a naturopath who then charged $250 for an “allergy test” where the patient held an ionized rod. They were subsequently diagnosed with an allergy of some sort and started on a $80 q2weeks supplement. As this was expensive for a fixed income patient they decided to skip the dispensing fees of their meds for the month so get all of this done. When they returned to me they were off medication with uncontrolled HTN and DMT2, $330 less and the same amount of abdominal gas. The naturopath ended up causing the exact opposite of the preventative medicine.
Well in response to your anecdote about your gassy patient, my mother had the same problem. Her Naturopath advised her to cut out dairy and gluten and voila — no more gas.
So, folks, if you’re willing to get a second opinion from another MD when things aren’t working out don’t be afraid to get a second opinion from another Naturopath, Homeopath, whatever.
With all the controversy over the high adverse risks of statins patients should do whatever it takes to stay away from them.
This is becoming a polarized debate when the issue is not about “naturopathy”, but one about select individuals. This distribution is not unique to any field of medicine as they all have quacks and schemers and those individuals should never be ignored.
The fact remains that any school of thought has diversity of opinion, various degrees of gullibility, greed, altruism, diligence, etc. My wife is a naturopathic doctor, has a BSc in molecular biology and is entirely evidence based in her practice. I know enough to know what I *don’t* know about medicine, but I do know a lot about what she goes through.
She routinely gets results outside of established medical norms, not by magic, but by staying current. She often finds herself at odds with (fewer lately) MDs looking for dated tolerances in test results, while her information is more current with sometimes hundreds of studies (in varying degrees of quality) to back them up. Her protocols are aligned with current information and THAT is why she is a good doctor. Science itself, is curious and doubtful without evidence, but humble and open to self improvement through hard work and discovery. Sometimes that takes the form of a new branch of medicine, sometimes that turns out to be a bad idea, sometimes not. Welcome to life and taking care of your health, we’re just not there yet.
Some MDs are readily open to new supplement or diet based studies, many are closed because of a rigid bias against “naturopathic medicine”. A good study raises interest, but consensus between many good studies should be paid attention to when possible and no one who treats the public, is entitled to actively ignore years of consistent, rigorous data, be they ND or MD, in the spirit of automatic bias.
It’s frustrating that some ND’s offer unproven treatments without a clear, unambiguous explanation, particularly for the NDs who are evidence based. People can pay for whatever they want, but a doctor can’t say something “works” without evidence in my book.
It’s equally frustrating that many MDs turn a blind eye to significant findings coming from naturopathic sources due to lazy / automatic bias, or getting the majority of their info from pharma. This is particularly troubling for image concious MDs who are interested in integrative medicine and don’t want to be seen as dinosaurs. (This is how some stubborn MDs are seen sometimes by evidence based NDs if you wonder what goes on in their heads)
This debate has heated up and has deteriorated from concerns about integrity and into forceful branding of naturopathy. This is symptomatic of either agenda or second order ignorance (ignorance of being ignorant) and is ultimately up to the patients to choose their doctor. In the end, you can’t get around trusting someone, you can only decide who that is. Ask your ND if they are evidence based, ask for studies and how they form their opinions. If they can’t answer the question more often than not, there may be a problem. I also tend to trust those who don’t make polarization their focus as they tend to look in one place to get their answers.
Indeed Jill. Indeed on a daily basis Western Medicine comes up short on many levels including; listening to the client, providing reasonable visit time as opposed to jam in as many 15 minute billings as one can, considering what else besides the almighty prescription, to name just a few. I enjoy a very positive and productive relationship between my Naturopath and my family physician. I am fortunate.
Family physicians jam as many appointments they can into their clinic hours for two reasons: 1 – they get paid roughly $40 per encounter from the provincial government. That is not take-home pay, that is revenue for the clinic that must pay rent, equipment, and salaries for ALL clinic staff. Therefore in order to stay afloat they must make enough revenue. They are not ethically allowed to charge more, and the Alberta provincial government actually tried to DECREASE the amount they pay doctors just this past year. 2 – There are currently not enough family doctors to go around, so wait lists and waiting rooms are stuffed to the gills and people complain when they have to book appointments far in advance and often say “can’t you just fit me in?”. And then people complain that doctors cannot take the time! Naturopaths, however, do not have either of these problems. They charge whatever they like straight from the patient, as well as making money from the products and supplements that they sell. Some people claim that doctors benefit from pharmaceutical companies, but this is not the case. Family doctors are often frustrated by this situation, and it is a strong deterrent for medical students choosing a specialty as they graduate. Is the answer to turn to a naturopath to receive questionable and decidedly NOT evidence-based care? Or to pressure your local government to reform the primary care system?
Thank you Carol. I entirely agree and would go further.
I was a dual educated ‘MD’ and CBT psychologist with extra training in such areas as physiotherapy, dietetics and even acupuncture in chronic pain relief. I should be the perfect holistic practitioner but I was prevented administratively from using half of my knowledge. Using the other half, really bare minimum diagnosis and therapy, was so time consuming that I burned out and have not gone back into mainstream medicine since but work on my own terms as a general psychologist mainly in education and the corporate world and as a personal developer.
I have also learned and worked on the other side of the fence with alternative health and am frankly insulted that those who know nothing about body or mind call themselves holistic practitioners. Shane’s wife sounds like the exception but far too many ‘alternative practitioners’ are hairdresser dropouts with their ethics, psychological skills and anatomical understanding of the body. They simply do not have the scientific background to handle information, mainly because of their passive aggressive use of language in which words are meaningless and used on the basis of being pretty or a manipulative in the worst way, the incomprehensible use of jargon as a weapon to disempower the receiver. They are disinterested in any form of truth except their definition that is dictated by popularity, book sales and Facebook likes. In fact, they are just lowest common denominator salespeople using all the lose/win, win/lose strategies used in the corporate world to sell worthless trinkets and unhealthy foods.
I have written various articles on these themes in my blog, cilnicalarts.blogspot.com.
My experience is that when used knowledgeably and objectively, particularly in conjunction and consistently with the principles of physiotherapy, lifestyle changes and evidence based psychology, they can act as a ‘super-placebo’ but the vast majority of ‘healers’ do not have the knowledge or morality to get anything positive out of their therapy. So I would be quite happy for ‘healers’ to be registered so long as the same standards were applied to them as to doctors, including examinations in statistical understanding and critical reading skills as well as holistic health knowledge!
You are as misinformed as the practitioners you attack. Every single ND that I know (and I know a lot of them) has at the very least a BSc, and most have an MSc. Naturopathy is based in science and ALL interventions are scientifically proven, if not in a pharm-sponsored study.
%featured%Your kind of misinformed vitriol is doing more damage to the health of Canadians than any “psuedo-science” could ever hope to.%featured%
“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.”
Exactly. So all MDs should be telling their patients that the antibiotics they just prescribed for a cold or a flu will be absolutely ineffective, considering the ailment is not bacterial in nature. But they don’t.
I would argue that the majority of MDs do not provide scripts for viral illnesses. Obviously it is not always possible to tell the difference between a viral and a bacterial illness (sinusitis and pharyngitis being some of the more common offenders) however we have guidelines based off research which aid the management of these common illnesses.
The majority of MDs I have trained under always provide teaching around viral vs bacterial illness and the risk of antibiotics (including the risk that we’re simply treating a virus and there will be no effect). I have continued this into my practice. It only takes one or two training “sessions” that take an extra 2-3 minutes. After that patients get the difference and are usually quite happy to wait out a sinusitis or AOM before representing for antibiotics. I realize that not all practices run this way but I would argue the majority do.
“Naturopathy is based in science”…
Yes. As much as astrology and alchemy are based in science.
You might not want your compatriot Laurie down below to see that. Lest she attack you too for “scientism”.
It isn’t based in science. You won’t find me wasting my time and money going to a naturopath!
Science is but one worldview. We who are the high priests of science would of course like the worldview to prevail (I am a practicing MD). If I didn’t believe in the general principles of science, I probably wouldn’t have risen within the priestly ranks to my current status. This seems pretty self evident and likely pretty innocuous. On the other hand my priestly powers give me a lot of power, prestige and by extension money. Can I really be objective as either an individual or as a collective priesthood when that power is challenged? Of course I can and should make arguments but should they simply be taken as valid because I say so or even because science says so.
Let’s be honest, medicine is a long way from a science. Ask any physicist what she thinks of the science of medicine. Sheldon Cooper’s dismissal of neuroscience is a perfect example of the response you might get (yes I know it’s fictional but I think it is pretty close to accurate on this point). We can’t very well hold up science as our right to power when we routinely ignore many of sciences basic principles. Even if medicine is a science and we as it’s practitioners can be seen as upholding those principles, there is nothing to say that society as a whole accepts or understands those principles.
I would suggest that a brief survey of the things that drive our societies decisions would quickly give one pause in any belief that science drives either individual or collective human decision making.
Supposedly paternalism went out of medicine decades ago but this kind of dismissal of any belief but our own and more specifically our patient’s belief when it conflicts with our own suggests it is alive and well. This is an important debate to be sure but we in the hallowed high halls of medicine need to start from the realization that we are failing our patients and therefore need to question and reevaluate all of our basic beliefs and see if they still serve us and more importantly serve our patients. To do this we must collectively try to define health in real terms that have meaning to our patients but then always be reay to reevaluate that definition in the context of the individual. Only then can we determine the tools that will allows us to achieve our collective desire of health and hopefully happiness. Clinging to dogma and doctrine without examination is unlikely I serve anyone’s purpose.
Yes Dan, Yes.
Beautifully stated, thank you.