Naturopathy Education in Canada

 
According to the Canadian Association of Naturopathic Doctors (ND), there are approximately 1500 NDs practising in Canada. The Council on Naturopathic Medical Education (CNME) is the accreditation body for NDs and lists the following schools:

  • The Boucher Institute of Naturopathic Medicine (New Westminster, British Columbia)
  • The Canadian College of Naturopathic Medicine (Toronto, Ontario)
  • The National College of Naturopathic Medicine (Portland, Oregon)
  • Bastyr University (Seattle, Washington)
  • The University of Bridgeport College of Naturopathic Medicine (Bridgeport, Connecticut)
  • Southwest College of Naturopathic Medicine and Health Sciences (Scottsdale, Arizona)
  • The Council on Naturopathic Medical Education has granted candidacy for accreditation to the National University of Health Sciences (Lombard, Illinois)

Identifying the schools gives us the opportunity to examine the curriculum requirements to become accredited as a ND in Canada. For an example we will look at the Boucher Institute of Naturopathic Medicine. For convenience sake, they have their full Academic Calendar available on line (PDF). First of all, the entrance requirements are defined on page 9:

Biology: one full-year (6 credit hours). This may be fulfilled either by one year of general biology or by one semester of cell biology plus one semester of an appropriate biology, such as botany, ecology, genetics, microbiology or zoology.

Psychology: half-year (3 credit hours). This requirement must be filled by introductory or general psychology. It is strongly recommended for the 2011 intake that applicants have an additional 3.0 credits of psychology in any discipline.

English / Humanities: one full-year (6 credit hours). This requirement may be fulfilled by courses such as:

General Chemistry: one full-year (6 credit hours)

Organic Chemistry: half-year (3 credit hours)

Biochemistry: half-year (3 credit hours)

In addition, prospective students would benefit by completing additional courses in some or all of the following areas showing a final grade of at least 73% or ‘B’: Business/Marketing, Calculus, Community/Cultural/Global/International Studies, Cell Biology, Ecology, Environmental Science/Sustainability, Genetics, Leadership, Management, Microbiology, Nutrition, Philosophy, Physics, Religious Studies, Research, Sociology, Statistics

The actual minimum requirements add up to one year of undergraduate study, but I assume that the majority of applicants would complete most or all of an undergraduate degree. By comparison, medical schools generally require an undergraduate degree and most require applicants to write the MCAT exams.

Once accepted into Boucher, courses are divided into five broad categories: Biomedical Sciences ; Professional Development; Naturopathic Therapeutic Modalities ; Clinical Science ; and Clinical Practice and Integration .

The language of the course descriptions is a mingling of the scientific and the pseudoscientific. In the sections that comprise the biomedical sciences, there is a definite vitalistic slant to the descriptions. However, the topics of biochemistry, anatomy, physiology, neuroanatomy, microbiology, and diagnostic imaging are difficult to criticize with the amount of information in the syllabus.

Within the component of Naturopathic Therapeutic Modalities are the following:

Botanical Medicine I–V

This series of courses provides an in-depth study of the botanical materia medica and the clinical use of whole plants and extracts.

Homoeopathy I-IV

This is a four-part sequence that prepares the student to prescribe homeopathic remedies in an acute and classical manner.

Nutrition I–IV

The Nutrition series examines the physiological functions, metabolism, and requirements for all macro- and micro- nutrients, as well as the pharmacological effects of individual nutrients…. The psychological meaning behind foods and food habits is also investigated.

Physical Methods and Agents Program

The Physical Methods and Agents Program provides hands-on training in physical assessment and physical medicine modalities. Included are the evaluation of soft tissue pathologies, orthopaedic testing, structural analysis, gait analysis, and examination and assessment of the vertebral column, pelvis, and peripheral joints. The principles and practice of goniometry and manual muscle-testing are introduced. Various systems of soft- tissue and osseous manipulation are taught such as Swedish massage, manual lymph drainage, trigger point therapy, neuromuscular technique, muscle energy, strain/counterstrain, craniosacral manipulation, fascial release therapy, and joint mobilization. Training in preventive and therapeutic exercise provides a foundation in the principles, techniques, and therapeutic application of exercise and stretching for improved strength, co-ordination, balance, posture, ergonomics, relaxation, and cardiovascular training.

The following eight courses comprise the Physical Methods and Agents Program.

NeuroMusculoSkeletal Medicine III provides an in-depth course outlining methods to accurately assess axial (spinal) dysfunction. Electrotherapy surveys the electrotherapeutic modalities and their application in a variety of conditions, including musculoskeletal disorders and pain management.

Exercise and Rehabilitation focuses on the rehabilitation of injured tissues as well as the maintenance of healthy tissues.

Hydrotherapy provides an education in the physiological principles and proper application of various, as hydrotherapy is at the root of naturopathic treatment.

NeuroMusculoSkeletal Medicine I allows the student to determine or identify pathological dysfunction in the muscles or joints of the body. hydrotherapeutic procedures

Massage describes the various techniques for soft tissue manipulation.

Naturopathic Manipulation is a four-part series of courses that provides a solid basis for the practitioner to determine the need for, and perform specific, spinal and peripheral adjustments of joints in the body. The primary focus is the spinal column.

NeuroMusculoSkeletal Medicine II investigates the standard orthopaedic examination techniques.

From these descriptions, it becomes obvious that the study of naturopathy contains some scientific practices such as physiotherapy. However, most of the courses involve unproven, useless, or dangerous techniques.

Homoeopathy, which makes a mockery of the basic laws of physics, chemistry and biology, plays a large part in naturopathy. Craniosacral manipulation is considered useless by Dr. Stephen Barrett at Quackwatch.

Spinal manipulations are the hallmark of chiropractic, a practice that is deconstructed in great detail by Dr. Barrett, and was dealt a serious credibility blow in England following a failed lawsuit against Dr. Simon Singh.

Hydrotherapy is merely baths of differing salts and temperatures that are recommended for such diverse conditions as hypertension, climacteric problems, and neurosis (a term that went out with Freud and Woody Allen). Despite the fact that most of us have used a bath for relaxation of pain relief, there have been a number of deaths in spa bath treatments, as reported by a team from Russia.

Botanical, or herbal medicine, involves the use of plant extracts, that may or may not have therapeutic value, but most of which are not regulated or tested in any way.

Another course area is Mind/Body Medicine

Mind Body Medicine examines a variety of topics in psychobiological healing, including bio-feedback, hypnosis and auto-suggestion, visualization and guided imagery, neurolinguistic programming, belief and the placebo response, prayer and meditation, shamanic healing, and focused healing intention.

This one paragraph deserves an entire blog post, but I will merely say that this entire section is best summed up by the words ‘placebo response’, which in scientific studies means that the placebo treatment is the equivalent of no-treatment.
Traditional Oriental Medical Systems I–V

This series of courses provides a working knowledge of the philosophy, theories of diagnosis, and therapeutic concepts and techniques of traditional oriental medicine. It emphasizes and demonstrates the use of acupuncture, tongue and pulse diagnosis, five-element theory, and the basic use of oriental botanicals.

Acupuncture is one of the most popular alternative treatments, but serious questions remain about its efficacy and safety. In fact, sham acupuncture, or acupuncture that ignores ‘proper’ placement of needles works just as well as ‘real’ acupuncture.

Tongue diagnosis relies upon the concept that parts of the tongue will show alternations based upon disorders of various organs. Pulse diagnosis is related in that the depth and strength of the pulse reveals specific details of a person’s health. I think it goes without saying that these concepts are not based upon any physiological knowledge.

Five-element theory is nothing more than a rehash of the Hippocratic belief in the four humours. A concept that disappeared many years ago.

According to the Canadian Association of Naturopathic Doctors website, one of the guiding principles of naturopathy is First Do No Harm (Primum Non Nocere), this includes as part of the elaboration—Your naturopathic doctor chooses remedies and therapies that are safe and effective. By this statement, every ND is in violation of their principles.

As of the day I wrote this post, the Standards and Ethics page of their site states <currently being updated>. That seems appropriate.

123 Responses to “Naturopathy Education in Canada”

  1. Anthony says:

    So some Canadian universities are offering a degree in literally nothing…

    That’s good news. No, really, it is! Since I didn’t go to university in the first place, I can say that I have a degree in Nothing, so now I can sign my name thusly:

    Anthony Allen, BNo

  2. Ray says:

    A 4th year student at the Canadian College of Naturopathic Medicine sent me, via a patient, a number of articles in support of Naturopathy and TCM and recommended a book titled The Web That Has No Weaver.

    I responded to all the articles and provided references to show that none of them stood up to the test of being scientifically validated. I got no response. When a copy of The Web That Has No Weaver finally arrived from the public library it was amusing to note that in the appendix the author cautioned the reader that there was no scientific studies to support the efficacy of TCM. Clearly the student had not read the entire book.

    That student is probably practising as a Naturopathic Doctor now.

  3. Lynn says:

    Its unfortunate that a large part of society would like to critique and demolish individuals who are trying to help, heal and re-due the damage pharmaceuticals have done for years. Never mind the lack of education around prevention. If only North America could be more like Europe, Asia, India in integrating more non invasive, holistic healing practices that went hand in hand with emergency medicine. If the condition is not fatal, then the practitioner should be acting with due diligence to ensure their patient gets all the care necessary – and not use the only tool in their pocket – drugs. The author would like to take away from people from healing faster, educating themselves how to take charge of their life style and move forward with a positive outlook. But perhaps going to see your MD for 15min with a piece of paper for a drug is satisfactory for your all.

    BINM, CCNM and the 5 accredited naturopathic school in the USA, has academic training comparable to any medical institute. What laziness, lack of effort for the author to go by the simple explanation a website gives. Just looking at Skeptic North, I would say it is run by a 12 yo. I didn’t try contacting anyone, which the author of the above article clearly neglected to do. Do medical institutes write a book on what they teach their students? No. They don’t. But I guess because you just ASSUME what they are taught is legit.

    If you are going to criticize a body of people without having any idea what you’re talking about, try asking. The Web that Has No Weaver – is a novel about TCM. TCM is one of the oldest, thriving medicines in the world. If you need research to help you sleep at night, perhaps you could try going on PubMed and looking at the use of acupuncture and see the research done on its benefit, nevertheless the ENDLESS research on herbal medicine.

    I would say the biggest idiot is the one who wrote the article. This person most likely goes to their local MD for help rather than an ND. A headache? Of course take a pill that will not only block any pain pathway but will erode your stomach and put more stress on your liver. Makes TOTAL sense….Try educating yourself on naturopathic medicine. It might do you some good

    • Dianne Sousa says:

      Lynn,

      If your interested in showing that naturopathy and every treatment modality used by naturopaths is effective you should be prepared for critical review. Simply wanting, or trying to help isn’t enough. You need to be able to prove that what you’re doing is legitimate. Naturopaths have failed to do this, which is why, in my opinion, they are not legitimate health professionals.

      You speculate about the author’s intentions and assume that if he does not provide a glowing review of naturopathy he must be ignorant and uninformed. But by your comments above you show that you’re the one who isn’t interested in worthwhile discussion and debate. I don’t see that you attempted to engage with any of the arguments that Mr. Underhay made.

      I’m sincerely confused by this point you make: “Do medical institutes write a book on what they teach their students? No. They don’t.”

      If by medical institute you mean school, then yes, they all write books outlining what they teach students. They’re generally called course catalogues. Also every course that I have ever taken at a university included a syllabus, which outlined the textbooks and required readings that each student was expected to have and understand. So you can see that it’s relatively easy to examine the legitimacy of a particular schools curriculum. Further this is necessary, since naturopaths regularly offer treatments and their own pharmaceuticals that have never been proven to work, or are simply implausible.

      If you have a clear argument as to why all naturopaths should be treated as legitimate health professionals, I’m willing to hear it. However, I don’t think your interested in integrating naturopathy and scientific medicine together. It seems that you think that naturopathy is superior to scientific medicince and should be used in substitution for it. I surmise this by your claim that MD’s lack sufficient knowledge about preventative medicine and only use drugs (which always cause damage) to treat patients. This is a claim that will be very difficult for you to back up, but since you are familar with pubmed you can go ahead and try.

    • Fred Trellis says:

      Quote.
      Its unfortunate that a large part of society would like to critique and demolish individuals who are trying to help, heal and re-due the damage pharmaceuticals have done for years.
      Endquote.

      Very well. Become a doctor.

  4. Lynn says:

    Oh, and one more thing. You will not be accepted to any naturopathic institute without an undergraduate degree. Guess you missed that when you perused the website.

    • Dianne Sousa says:

      Whether the applicant has an undergraduate degree is unimpressive to me, since when they become naturopaths they go ahead and do the opposite of what they learned during the legitimate portion of their education.

      • Lynn says:

        Your rebuttal doesn’t make any sense. Naturopaths spend two years diving further into cellular biology, organic chemistry, physiology, anatomy – then into pathology, oncology, paediatrics, geriatrics, neuroanatomy and more. So….unless you did an undergrad in fine arts with the prereq requirement of university basic chemistry, biochem, organic chem, biology, you are not
        doing “the opposite of what they learned during the legitimate portion of their education.”

        Furthermore, each naturopathic institute has an academic catalogue. The author of the article didn’t refer to the catalogue but simply what they saw online. Medical institutes don’t supply a detailed outline on line. If you want the info, ask BINM or CCNM or the other institutes what the students learn. Become a bit more educated before you criticize. In addition, many of the courses naturopathic students learn are taught by the exact same professors who teach at medical schools – this is happening at BINM. MD’s are involved in the teachings. ND’s are also involved in doing seminars at medical schools such as at UNBC. Integrative medicine is happening if you like it or not.

        Oh, and legitimizing naturopaths? That’s easy. That’s all any medical practitioner was before penicillin was developed in the 30s. From then on, there became a divide between those who prescribe and those who don’t. Oh, and now naturopaths prescribe in BC with Ontario to follow. Portland and Oregon naturopaths have been doing it for years. Now when you are prescribed antibiotics, I guess naturopaths can prevent your yeast infection with probiotics. But I guess you need scientific evidence that probiotics work since everything naturopaths do is not legit.

      • Dianne Sousa says:

        Lynn,

        Let’s assume a naturopath has an undergraduate degree in chemistry (or really any science – the argument would be the same) and then attends Boucher where they learn to prescribe homeopathy. If they use homeopathy in their practice they would be doing the opposite of what their education in chemistry would have indicated, namely that homeopathy is implausible. I hope that makes my point clearer for you.

        Bottome line Lynn, you cannot opt in and out of science as you please. If you buy into the idea that there is no objective reality and therefore science is only one way to know things, you leave yourself saying things that contradict each other. Worse, you don’t seem to recognize that this is what you’re doing. You have no consistent standard of evidence.

        To be clear, I didn’t say that everything naturopaths do is illegitimate – I said that they are not legitimate health professionals. I hold this opinion because I have considered the entirety of what naturopaths claim and do and I find that a lack internally consistent ideas, a lack of sufficient evidence for efficacy, and enough potential for harm (including harm by ommission) that they should not be allowed to practice as they currently do.

  5. @Lynn No, I did not examine the entrance requirements for all schools, I used Boucher as an example. Those for Boucher are copied from their website and do not equal an undergraduate degree. As far as the actual education is concerned, perhaps you could write up a comparison of the training involved in medical school as opposed to naturopathic school.

    I will ignore your ad hominin attacks and suggest that you do some research, focusing primarily on reviews and meta-analyses rather than individual studies to examine the actual efficacy and safety of the treatments. Unless you are prepared to examine the experimental model and critique the statistics and conclusions, individual studies can be very misleading.

    Ancient says absolutely nothing about effectiveness. Treatments need to constantly re-evaluated to determine if they actually have the effect originally supposed, or if a newer treatment might have better outcomes. Sometimes the newer treatment is better, sometimes the older proves to be the better.

    I would be very interested in seeing a detailed answer, preferably without the insults.

  6. @ Diane. The entrance requirements do play a role in a person’s complete education.

    I’m do agree with the unlearning aspect though. I know an ND who has a PhD from the same department I received my MSc. I couldn’t believe it when she resurfaced as an ND.

  7. Mark says:

    John,

    Look again at the Boucher Institute website regarding admissions requirements (http://www.binm.org/index.php?option=com_content&view=article&id=147&Itemid=107).

    An undergraduate degree is required as it is a graduate program. The prerequisites add up to 30 credits and are separate from the undergraduate degree requirement, as they also are at allopathic medical schools.

    Sincerely,

    Mark

  8. Mark says:

    John,

    For a comparison of curriculum for some MD versus ND programs please see this site: http://www.bcna.ca/

    Scroll down on the main page and find the link to the PDF (comparing ND and MD curricula). Please note that this comparison is for NCNM and Basyr University, both CNME accredited schools in the US. The Boucher Institute curriculum has additional pharmacology hours as NDs have prescription rights in BC, so the curriculum reflects the added scope.

    Happy reading and happy learning!

    Mark

  9. Rae says:

    Hello John,

    I would suggest you contact someone at BINM if you would like more information on both the actual requirements to get in to naturopathic medical school (an undergraduate degree is in fact a requirement), and if you want a comparison between MD and ND education hour for hour, these stats have been researched and are available. Based on your article, you will likely be surprised at how the hours dedicated to the sciences compare (in some cases, we actually average more than MD’s).

    As far a scientific validation, naturopaths are keenly aware of the fact that in order to “believe” something works, many people require a scientific study of some kind. Which is why there is an emergent body of literature that has come out in the recent decade both on the use of both individual remedies and substances (in treating certain conditions), and on macro ideas, such as clinical effectiveness of naturopathic and complimentary care.

    It’s odd to me that there is still such an argument about whether there is “scientific proof” of natural therapies, when all it take is a quick pubmed search on a specific substance of therapy to reveal whether the data exists. For a start, you could get a subscription to Natural Standard, just one of the many databases that seeks to compile a lot of this research, categorized by subject or therapeutic modality.

    To say that Naturopathic medicine as whole is not “scientifically proven” is really equal to saying that conventional medicine is not “scientifically proven”. You have to get down to specifics if you want to be intelligent about this discussion. There are tonnes of pharmaceuticals prescribed every year for things that studies have not been done for, many of these fall under the category of “off label use.” And if you research the deaths caused by improper prescribing, or drug side effects (i.e. liver failure from tylenol), or surgical mishaps, you will be astounded at the numbers. It is not a made up “myth” that naturopathic medicine is overall a very safe and effective medical practice, especially if you compare the numbers to the regular medical system. This is not rocket science research.

    Because of the focus on evidence based medicine now in our practice (which I’m not sure is necessary to provide safe and effective clinical outcomes myself), the next decade will only “prove” to those skeptics out there that naturopathic medicine is effective. I’m totally confident of about this position.

    In the meantime, I do feel that your article is a little misinformed, and having taken my share of research classes in university, as well as in Naturopathic Medical school, I can see that you haven’t really dug that deep. We are all human, and we all do this, but this is clearly a case of internet fact searching only to validate ones own opinion. There are ample “facts” out there to validate any opinion on the planet, but this doesn’t necessarily correlate to reality.

    If I wanted to criticize the regular medical system, which I don’t want to do, this is what I would do: I would go see a really horrible medical doctor with a bad reputation; I would then look online for all kinds of negative stats on pharmaceutical drugs, and how they are all funded by big corporations, then I would go sit in on some medical classes at the local university and be dismayed at class sizes, and profs that don’t speak english, talk to a bunch of people who have had horrible side effects from drugs, then write an eloquent article about it.

    Sound like a good strategy?

    • I have already admitted that I was in error about the entrance requirements. If someone can show me proof of something I am usually willing to admit my mistakes.

      While there are individual studies that suggest the efficacy of various treatments, it is to the meta-analyses and reviews that we should be looking for to determine the value of any treatment. This is true of all medical interventions, ue of all medical interventions no matter the source. In fact it is one of the hallmarks of science based medicine, and science in general, that everything should be continually re-evaluated.

      There are many people involved in pharmacognosy or the study of medicinal plants. The appropriate method of study is to determine whether or not a plant or its extracts have a beneficial biological effect. To assume that because a plant has a specific value because of its historical uses is not a useful recommendation for future use.

      I did not claim that naturopathic medicine as a whole is not “scientifically proven”. I chose very specific examples of non-scientific modalities that a taught in a ND program. What I do ‘believe’ is that the material I referenced provides a damning critique of those examples.

      You criticize the focus on evidence in medicine and yet you peg your hopes on future proofs of your current beliefs based on scientific research. Research that has yet to prove the effectiveness of most of these ‘natural’ cures.

      As far as your criticism of modern medicine using treatments that eventually are proven to be more harmful than useful,that is very unfortunate, but in the end, science will out and these practices will be dropped. This is in contrast with what I observe in the CAM world, where things such as homoeopathy are obviously useless and defended with great vigour and obviously still taught in ND schools; or of the ubiquitous “it’s ancient, so it must be good’ attitude’ we have seen on this page and throughout CAM practitioners and supporters.

      The actions of”Big Pharma” are a serious issue and are constantly being discussed in the science based world. Again in contrast with the denial that multinational corporations such as Borion have a huge monetary stake in the promotion of homoeopathic products.

      To summarize, self-criticism is the norm in science based medicine, and seemingly are in CAM.

  10. Mark says:

    John,

    You are entitled to your opinions, as we all are, but I recommend you do some more research before putting pen to paper. The fact that you were unable to determine that an undergraduate degree is an admissions requirement to Boucher (clearly stated on requirement page) makes me question your ability to critique the course content.

    I suggest you do an informational interview with some practicing NDs or even contact the CAND (http://www.cand.ca/) to learn more about what naturopathic medicine is and why so many people are seeking their assistance. I have both an ND and an MD as my health care providers, and it is a collaborative and comprehensive approach to my own health care. NM is a regulated profession for a reason and you should look into it further before writing such a narrow-minded article.

    Thanks for your response and best of luck in your explorations.

    Mark

    • I will take issue with your inference regarding the regulation of naturopathy. Naturopathic medicine is a regulated profession only because of its popularity and potential for harm – those are the major criteria used by the government as a regulatory college exists to protect the public, not promote the profession. Efficacy of treatment is considered a professional standard that the college is responsible to uphold but not a real consideration when choosing to regulate or not regulate. It is seen to be under the jurisdiction of Health Canada as regards the actual medicines and devices used (this comes directly from the MOH personnel I have spoken to about regulation.)

      • Lynn says:

        Micheal,

        So your point is naturopaths exist because they do harm? And you are then stating MD’s do harm.

      • Michael Kruse says:

        No Lynn, that is incorrect. My point is that Naturopaths are regulated because of the potential for harm. This statement has nothing to do with their existence, that is an entire other discussion. That is why there are ethical codes and standards of care required in most professions, so there can be an expectation that the professionals practicing with a licence do not take economic/sexual advantage of their patients in the former case or act outside their scope of practice or provide dangerous, unproven treatment in the latter case. Regulation is about protecting the public, not legitimizing the profession. The college also exists as a recourse for complaints against its members if a patient or member of the public perceives harm from a licensed member.

  11. Reactive opinion says:

    John and others cut from the same cut of cloth,

    If you are not already very sick, when you become so, please please be sure to only seek the help of the allopathic profession who practice “real medicine”. It would be a shame to seek any other help than that prescribed to you by the dogma of society. Please let me know how it goes being subscribed so blindly to “evidence based science” and being so angry and committed to sharing the ‘truth’.

    In hopes of a narrower view,
    Jane.

    • Kim Hebert says:

      You use the term “evidence based science” as if that’s a bad thing. If not evidence to justify a medical treatment, what is your alternative?

      • Lynn says:

        There is nothing wrong with evidence based medicine. It gives people a sigh of relief to know that the drug they will ingest was first tried and proven OK in rats. Because rats and humans are the same, I guess this qualifies “evidence based medicine” as a legit use?

        The bigger problem is John and many others succum to idea that what a billion company has proven, must be OK. But when naturopaths prescribe something, that doesn’t have the weight of a research company behind them, such as practices in homeopathic medicine, TCM, botanical medicine (of course there is millions of dollars of research done in bot med – where most pharm drugs came from) to massage, nutrition, chiropractic – should be thrown to the side.

        Evidence is certainly a basis for truths to be told – but it isn’t the be-all-end all. There are thousands of dollars done within naturopathic medicine – nutritionally, acupuncture, bot med, ect ect.

        But….Why does one thing work for someone but not another? Why do some millions of people die from pharmaceuticals and others don’t? Most likely because we didn’t see the report and the gov’t allowed the drug to hit the market. Evidence medicine can be a very scary place. Money talks – Viagra was for heart conditions, not erectile dysfunction. That drug certainly flew off the shelves. Or what about use of Tylenol as an anti-pyuretic, which is given to babies when they have a fever. Anyone think about their tiny liver? Or how it can predispose them to asthma if overused? Naahh. The evidence didn’t tell us that. We get to figure that out on our own. Tampering with synthetic product can be very dangerous.

        By introducing non-invasive techniques, living a life free of toxins, decreasing stress, is the evidence we need to prevent dis-ease. Things naturopaths do, are safe. The evidence comes in when figuring out what conditions need higher doses of certain nutrients. Or how green tea is excellent for cancer patients. Or how high doses of CoQ10 can help decrease parkinson symptoms by 20% (study done at Harvard University). Naturopaths can be invasive with their techniques such as IV therapy, Neuro therapy, draw blood for labs (exact same labs as MD’s do – CBC with differential, TSH, Ferritin ect) but certainly don’t give toxic substances to people like candy. Naturopaths are trying to undue the harm drugs and their evidence have done for years. Drugs certainly have their place – with emergencies. You can either see a naturopath or go to the emergency – that is if you want to live a life preventing disease and living in harmony with your body. Or you can stick to the narrow evidence based path that doesn’t steer too far away from its rich employee.

      • Kim Hebert says:

        Well you and others have explained at length why certain evidence is bad (i.e., evidence that you don’t agree with) and why science is terrible (i.e., people have made, in hindsight, some mistakes), but again I ask all naturopaths commenting here: what is your alternative? Science is a method of testing ideas to make sure results are consistent. Evidence (partly) is what results from several of these tests objectively agreeing with each other, either positively or negatively. It’s not a perfect system, largely due to human error and not the *concept* of objective testing itself, but it’s the best we have. So if not science and evidence, then…what? Guessing? We go back to the dark ages? Dogs and cats living together, mass hysteria?

        How do we know what is true other than to simply observe and investigate? Philosophers, and later scientists, have been using and perfecting this method for thousands of years (I.e., look at something, write it down, test it with variables eliminated) – and since “thousands of years” is itself enough justification to use acupuncture, surely thousands of years of success and significant contribution to modern culture counts for something? By dismissing science and evidence because you don’t personally agree with a lot of it, you dismiss thousands of years of philosophy and learning. You dismiss most of the modern comforts you enjoy today. And you dismiss the noble human endeavor to explore and learn all that is possible about our world and the universe it lives in. And yet you provide no alternative method of learning (but you seem ok with citing studies when they agree with you).

        It’s easy to tear things down, much more difficult to replace what’s torn down with something valuable. We already have science. It’s not a conspiracy, it’s a tool that works very well to provide you with the relatively cushy life you now live. What can you offer me that’s better?

      • SVM says:

        Lynn, before a drug is introduced into the market, it goes through extensive Phase I, II and III trials – trials that include upwards of 3-5K participants. This is done so we can prove a) efficacy and more importantly b) safety. It is completely irresponsible for anyone to recommend using a product that lacks necessary data.

        As to your second point on how pharmaceuticals kill people – well, you have proved my point yourself. Even WITH safety data on thousands of individuals, such incidents occur. So yes, ‘evidence based medicine’ is imperative – of course, only if well-being is your primarily goal.

    • Crommunist says:

      I’d encourage you to take your own advice and only use “naturopathic medicine” the next time you are seriously ill. When you have a heart attack, tell the paramedics to put away the defibrulator and pull out the oil of oregano.

      But no, I don’t actually want you to do something so self-destructive and stupid. Even if you think that having to demonstrate that something actually works better than placebo is a mark AGAINST it somehow, I hope you never are in a position where your ridiculous delusions actually harm you.

      • Jan says:

        Crommunist, i can’t imagine there are any ND’s out there that would have such ludicrous advice. Nat. medicine has far greater use in prevention. Prevention is the cure. And a lot cheaper on our system too. i.e; if you’re healthy and have an in-depth holistic understanding of your body and it’s needs, you’re far less likely to have a heart attack in the first place. And if you do, there’s other effective medical options to deal with it. Then back to Nat. med to help eliminate the toxins from pharma drugs used to treat you in the hospital.

      • Kim Hebert says:

        You imply naturopathy is doing something different by encouraging prevention. Medicine is preventative as well, but it also treats when necessary because it is capable of doing so. Doctors can tell us until we are blue in the face to eat right an exercise (and they do), but we have to listen. Lifestyle is a patient responsibility, so there is no difference between medicine and naturopathy with regard to prevention. And there is no proof that the various tinctures and colon abuse offered by naturopathy has any role in preventing anything.

        Given the above and that others commenting have made it clear that naturopathy is based on personal experience and not solid, objective proof, why does naturopathy deserve to be chosen over medicine?

    • Mnementh2230 says:

      So let me get this straight – you prefer an alternative you can’t even prove to be anything more than wishful thinking to something that has been proven to be effective?

      I suppose you think homeopathy is a legitimate field of medicine as well?

  12. daijiyobu says:

    You guys kick ASS.

    -r.c.

  13. Robyn says:

    this entire article is completely biased hyperbole based on speculative assumption.

    if this website wants to present a case, do not just take the side of refuting using ad hominem language. the true job of a skeptic is to unbiasedly present proper evidence, not just be an angry old man.

    As a person who benefits from naturopathic medicine, i can concur that i have seen drastic health improvements following the expert advice of practitioners. So, speaking from actual experience devoid of relying on anecdotal evidence I can agree with the facts presented by the naturopathic community.

    when forming an argument to expose facts about a claim, please remove the negative personal biases first. it will help your credibility.

    • Kim Hebert says:

      When you use personal experiences to draw a conclusion, that is the definition of relying on anecdotal evidence…

    • Robyn, what is a ‘speculative assumption’ made in the article? Your criticism would be more meaningful if it was specific. If the author made a factual error, please point it out. If he wrote something that cannot be supported by evidence or documentation, please say what you think it is.

      The statement “actual experience devoid of relying on anecdotal evidence” contradicts itself. Experience IS anecdotal.

    • Steve Thoms says:

      Robyn:
      You said,

      when forming an argument to expose facts about a claim, please remove the negative personal biases first. it will help your credibility.

      And with seemingly no grasp of irony, you said this in the breath immediately following,

      “As a person who benefits from naturopathic medicine, i can concur that i have seen drastic health improvements following the expert advice of practitioners. So, speaking from actual experience devoid of relying on anecdotal evidence I can agree with the facts presented by the naturopathic community.”

      You literally are using your own personal experiences as a substitute for evidence!

      Speaking from experience IS an anecdote!

      How you do you suggest those of us without your experiences proceed? We’re supposed to take your word for it, and then we get called “closed minded” when we patiently try to explain it to you that we need evidence, not your personal stories.

      Frankly Robyn, and every naturopath that has come here so far, let me be blunt, because I grow weary of being subtle:

      Your personal anecdotes and experiences are insignificant. If you think your stories trump evidence and RCTs, no matter how many many stories you may have, and how much you believe them, you’re wrong.

      Your experience is nothing compared to centuries of a proven scientific method.

      If you think otherwise, it shows not only your unwillingness (or inability?) to accept methods that go against your faith-based positions, but it also shows your incredible ego.

      Your truth, is not *the* truth.

  14. Would we take an astronomy curriculum seriously if it contained courses in astrology and UFOs? Obviously not. How then can we take seriously an allegedly “medical” curriculum that includes homeopathy and acupuncture? The mental gymnastics required to overcome such contradictions pervade alternative medicine.

    NDs will be quick to assume that I am judging from the outside and know nothing about it, but they’d be wrong. I am an alt-med apostate. I was trained in a curriculum with a similar character — pseudoscience and quackery mixed in with anatomy, physiology and pathology. I swallowed it whole at the time. After several years more study, I decided that I’d been duped … and changed my mind. And my career.

    • Abber says:

      I like your analogy which uses the example of UFOs and astrology. I’d be skeptical of an astronomer’s explanation of star birth if I also knew they believed planet alignment could affect our lives and our personalities, but that is nothing compared to the deep suspicion I have of naturopaths who peddle some downright quackery. I don’t care how much they know about nutrition and cell biology, my health and that of my family is far too important for me to put it in the trust of these people.

  15. Throughout this discussion, I have yet to see referenced support for the specific non-scientific modalities such as acupuncture, homoeopathy, hydrotherapy, tongue and pulse diagnoses, and five-element theory, that I discuss in my post.

    It is in the teaching of these types of subjects that I base my greatest criticism of naturopathy.

  16. Jann Bellamy says:

    There are several good posts at Science-Based Medicine discussing the many problems with naturopathy, starting here:
    http://www.sciencebasedmedicine.org/index.php/another-state-promotes-the-pseudoscientific-cult-that-is-naturopathic-medicine-part-1/. Mark should not take much comfort in the fact that naturopathy is a “regulated profession,” as explained here:
    http://www.sciencebasedmedicine.org/index.php/legislative-alchemy-i-naturopath/.

  17. Rae says:

    I think the collapsing health care system and the fact that Canadians spend 1/4 of their tax dollars and rising on our health care system is ample evidence for me that the conventional model isn’t working.

    The real argument should not be “evidence-based” vs. non-evidence based, but rather current health care model vs. alternative model. It is a political question and not a scientific one, and is being asked by millions of sick people caught in a system that is failing. I’m not sure about the US, but this is not something “argued” about in Canada, its just reality for most of us. And we apparently have a better system than down south.

    Chronic disease has been on the rise since the turn of the century, we are getting sicker, not healthier. There have been some wonderful milestones in health care that (scientifically) have been attributed to the majority of advances in quality of life and life expectancy over the past 200 years; namely proper sanitation, clean water, and antibiotics. Nobody will argue that these were amazing inventions.

    I have seen argued in these posts that naturopathy and conventional doctors somehow have come from “different” roots or traditions, when in fact, until late last century, all of us were practicing in a hodge-podge of what is called “western medicine”. At the turn of the century, some physicians politically sided with the pharmaceutical industry (read up on the Flexner report) after which point (with the backing of big dollars) ACTIVELY tried to squash any and all forms of other medicines in existence at the time. The reasons for the attack had nothing to do with the scientific method, but had to do with making money, plain and simple. All forms of western medicine at the time touted “evidence based” philosophy, as we are all children of the “revolutionary” enlightenment era, when Galileo first stated that, in fact, the Earth revolved around the sun (and not vice versa).

    No one is against evidence anywhere in the western health care profession that I know of. At the turn of the century and before, many books and anecdotes amounting to hundreds of volumes were amassed based on basic observational techniques, which continue to be the basis of the scientific method. However, the standards of laboratory research that is demanded today requires millions and millions of dollars. And if you can’t isolate and patent a single ingredient, you can’t make money off of a substance… and therefore you cannot afford to do the research.

    Older forms of medicine have hence lived in the shadow of big pharma, and have simply had to continue to treat people as they always had: based on good values, observation, modification based on real-world results, and good record keeping. As the industry has begun to gain monetary momentum, it has begun to do the type of research that the current medical industry requires (of this means that neutraceutical companies are bought up by pharmaceutical companies, but oh well!). But truly, if we all cared as a SOCIETY about people’s health, we would drop the idea of being on “sides” and choose to do more research on all of these valuable treatment modalities (meta-analysis or what have you), so that people could start getting the services they needed, in a legitimized fashion. (Or at least in a fashion that would convince skeptics out there! :)

    In British Columbia, ND’s, due to ENORMOUS public and political support, are considered general practitioners. We learn all the same science and research on all the conventional pharmaceutical treatments that MD’s learn, as well as anything that is possibly available on alternative care (as it become available). What differs us from others is our basic core values. While “prevention” is touted as a value in conventional medical philosophy, most MD’s would agree that financial restraints, 10 minute visits, and lack of experience in this realm, force them to perform quick fixes over comprehensive and individualized patient care.

    And yes, as naturopaths, we do actually value evidence that is “anecdotal,” (oh dear, don’t hang me now!!) as being equally valuable from a clinical perspective as all those myriads of scientific studies…. as long as the therapy is safe. Both of these “ways of knowing” give us insight on what is “true.” They are both windows into the multi-dimensional nature of reality as experienced by this complex species we fondly call homo-sapien. BOTH have tremendous limitations, as well as great potential. For example, science allows us to see what works well for the “average” human being (due to how samples are selected, etc.), and anecdotal evidence gives us insight into the little things that might help us tailor treatment to an individual who isn’t responding to conventional treatment. These are gross generalizations used simply to make a point, but they aren’t far form the truth in many respects.

    The last point I would like to make is about safety. At least in licensed provinces in Canada and the US, there is enough awareness and legislation, and even studies, to show that naturopathic medicine as a PROFESSION is safe (by many standards). What makes any treatment modality safe is the knowledge of those practicing it. Any herb, drug, or even food substance, can be lethal at a particular dose. Generally speaking, substances that are considered “natural” (minus a few exceptional herbs and other chemicals that are taught to death in school), have much wider “windows” of safety. I.e. with many drugs it’s a matter of milligrams that you could cause death, but with herbs, we are talking much larger amounts. In any case, we learn extensively about their application and potential interaction with drugs, and so on and so forth.

    Thank you for your time. If I seem angry, I am actually not. We face these kinds of discussions all the time in our profession, and yet I remain totally happy and positive about what I am doing. It is one of the most rewarding professions in the world — a testament to the amazing journeys we are able to go on with our patients, a relationship which allows us to grow and heal as much as they do… and heal they do.

  18. First of all, in your your comments referring to ‘the last century’ shifted back and forth between the 19th and 20th centuries. It made for confusing reading, but I think I get what you are trying to say.
    I have read this several times and, like many comments I have read by proponents of CAM, what I see is that evidence is something to be striven for in proving the effectiveness of their favoured treatments. At the same time, evidence that does not support those treatments is denigrated. This is done by claiming either that the scientific method will not work on these treatments, or that medicine is controlled by ‘Big Pharma”. Claiming that it takes too much money to research is admitting that many of the treatments you use have no evidence to back them, up. The difference with science-based medicine is that the unethical tricks employed by pharmaceutical companies are eventually exposed, and are then dropped, often resulting in law-suits. However, ultimately there is accountability. Perfect? A long way from it, but ultimately progress is made.
    In your comments above you make this claim, then immediately follow it up by noting that nutraceutical companies are being bought by pharmaceutical companies “Oh well”. So does that mean you now don’t trust or use products from these companies?
    Personalized medicine? I think that nay good physician uses their own experience and that of others to individualize treatments. They are also prepared to challenge their ideas is evidence proves them wrong.

    You admit that science has advanced public health in many areas. Some of these, such as healthy lifestyles based upon diet and exercise have been claimed by the CAM practitioners. I challenge you to find a MD who will not counsel an overweight patient to make those changes, even if they only have 10 or 15 minutes. In this you are being disingenuous in conflating these lifestyle diseases such as diabetes with modern medicine. They are the result of people ignoring for many reasons the advise of MDs. Can you give examples of non-science based improvements in public health?
    The problem of 10 – 15 minute appointments, as you say, is a problem with the structure of physician remuneration, rather than a problem with the actual practice of medicine. Your claim that they lack expertise is an insult to them.
    Popular and public support for NDs to prescribe is no proof or even recommendation or even proof in the effectiveness of treatments. One of the issues MDs face is patient demands for the ‘quick fix’. Ritalin, Viagra, and anti-biotics, are three that come to mind immediately. It doesn’t mean all of these prescriptions should be written. Many people would rather take a pill than make the lifestyle changes recommended by their MD. One may criticize the persuasiveness of the individual MD, or their willingness to acquiesce to patient demands, but that says nothing about the recommendations themselves.
    You also claim that more research needs to be conducted on CAM treatments. Homoeopathy is dead in the water, acupuncture has not done well in comparisons with ‘sham acupuncture’; NCAM in the US has spent millions without any positive results. How much more research is needed before these concepts are dropped by your profession?
    One of my other criticisms concerns the business model of naturopaths. I can’t speak nationally, but all of the NDs in my province (PEI) sell the supplements, herbs, and their materials they recommend for their patients. In the US, some physicians are selling common prescription medications, but the ethics of that practice is being publically debated. Personally, I see this as a huge conflict of interest, whether by MDs, NDs, or anyone else.

    • Mike says:

      peicurmudgeon wrote: “The difference with science-based medicine is that the unethical tricks employed by pharmaceutical companies are eventually exposed, and are then dropped, often resulting in law-suits. However, ultimately there is accountability.”

      Is that so? I was under the impression that when it comes to vaccines, the drug makers have been granted immunity from lawsuits. So ultimately, there is no accountability.

      • You are talking about two different things. Ongoing research determines the effectiveness and safety of drugs. Misrepresenting one or both of these cannot be hidden indefinitely. The withdrawal of Vioxx is an example of this.

        The point about protection for vaccine manufacturers is completely different.
        In the US, there is special court known as the The Office of Special Masters that is within the U.S. Court of Federal Claims. It was established to protect vaccine manufacturers from spurious claims, while providing individuals with appropriate redress for harm. The rules are here:
        http://www.uscfc.uscourts.gov/sites/default/files/11.07.15finalversionofvaccinerules.pdf

        The public health benefits of vaccines far outweigh the potential for harm, thus the need for protection.

        Outside of the manufacturer of the swine flu vaccine, I am not aware of any protections in Canada. Perhaps others can help out here.

        If evidence of harm from vaccines is proven by the science, changes will be made.

      • Mike says:

        I still don’t see the difference between the two. Isn’t ongoing research also used to determine the safety and effectiveness of vaccines?

        Why is it that drug companies need protection against spurious claims related to vaccines but not against spurious claims related to other products?

        What I take from your comment is that you’re implying that vaccines are so important that we must change the rules and instead have the government assume accountability for any misrepresentation of safety or effectiveness when it relates to vaccines.

  19. Rae says:

    I understand your points, but I would like some clarification on one of them in particular: In my combing of the literature out there, there are a plethora of examples of drugs that have been scientifically proven to be unsafe that are still on the market and being used… (Even if you look just at deaths caused by certain substances, never mind long term side-effects, etc.)

    I don’t know what research you are looking at that’s different than mine, if you could provide databases other than pubmed and the usual for journals, or even some social or political studies, I would look at those as well. In my research, self-regulating capacity of the medical and pharmaceutical industry has not been proven scientifically or politically. That is your opinion, or someone else’s opinion, not based on any evidence that I am aware of. So if you have some more information to back up that point, I would be very interested in it, as it’s a topic that I am very interested in, being in the health care field.

    Thanks!

    • Kim Hebert says:

      The author and other commenters have pointed out serious, and so far inadequately defended/answered, shortcomings with naturopathy and your response is “well look over here to what drugs have done”. This is a red herring. How does any of what you’ve said justify objectionable naturopathic modalities? Let’s get back on track here. Two wrongs don’t make a right.

      How do naturopaths determine what NOT to use as a treatment? It seems that whereas the medical community eventually separates the wheat from the chaff using science (allowing for smug naturopaths to then point out all the mistakes made in medicine), though admittedly this process is sometimes infuriatingly slow and riddled with bureaucracy, naturopathy seems to have no basis for determining which treatments are appropriate or inappropriate. I’ve asked for this information here 3 times and have not so far received an answer (instead only digressions into perceived flaws with medicine).

      It seems like the scientific community is being held to an impossible standard while at the same time naturopathy has completely inadequate standards. That is simply not acceptable.

      • Rae says:

        I guess what I was trying to say is that the conventional medical system doesn’t ONLY use science to determine what treatments to use either (and I don’t think that amounts to two wrongs, but rather two rights). Vaccines are an example of this, most have and continue to be approved without clinical trial, and no long term study on their safety over time.

        The way treatments are deemed appropriate or useable has to do with science in the same way that conventional medical system uses it (remember, we use many “conventional treatments”, as well as watch for safety and clinical efficacy over time. These things can be documented from case studies from individual doctors.) The conventional system also uses this method to find new treatments, new uses for drugs, and so on. It relies much less than you think on “science”.

        And I’m also getting a little confused about the use of the word “science”, it can mean all kinds of different things (I have been involved in lots of “science,” and have even worked at one of the larges pharmaceutical organizations in the world in Europe as a lab technician).

        There are tonnes of studies done on alternative treatments out there, and you have to look for them just like any good researcher, but they aren’t that hard to find. I think if you are that concerned for public safety and concerned whether the treatments many ND’s are offering are safe and effective, start looking it up! Seriously! I would like to see a study done on the “unsafety” or inneficacy of a treatment. Not only that, I want to see TEN done on each, because most good scientists know that you need to repeat something at least this many times to know whether it’s true. (i.e. one study on acupuncture that is poorly set up doesn’t suffice. That’s probably why MD’S still use it here in hospitals, because they are finding it actually works).

        I personally don’t have time to start citing specifics here, especially if you don’t give me something specific to look up. In the meantime, medicine, both conventional and alternative, will continue to be more of an art than a science. It’s not like ND’s don’t ever talk to MD’s (I actually know a few MD/ND’s actually), I know many, and as far as I’ve ever heard, they would whole-heartedly agree.

      • Kim Hebert says:

        Science means one thing. One specific thing. And you still didn’t answer the question. Instead you’ve assumed that I don’t know about naturopathy-related research, because if I don’t agree with you I must not have, right? And it must all be of robust quality right? If only I would just look at it (I have – with regard to homeopathy, for example, see my article “Evidence check: Bryce Wylde’s 21 favourite papers). Another digression. Answer the question: how do naturopaths tell what modalities not to use? How much evidence would it take to convince a naturopath that homeopathy, for example, doesn’t work? I don’t want you to cite a list of studies. I want you to answer my question.

        Edit: and by the way, your information about vaccines is wrong.

      • Scott Gavura says:

        Quote:

        “Vaccines are an example of this, most have and continue to be approved without clinical trial, and no long term study on their safety over time.”

        When I search PubMed for vaccines (limit: clinical trials) I get 10,713 results. Which vaccines have been approved for use without clinical trial?

      • Dianne Sousa says:

        Rae,

        I’ve read through all your comments here. You don’t seem to fully grasp the content of our critique. I think this is why you have repeatedly dodged the fundamental question that Kim has repeatedly challenged you with. Perhaps you can’t answer because naturopaths don’t have any standard by which they decide what ideas and practices to discard.

        You don’t even have a standard that you use to decide what to include in your practice. If you do, it isn’t evidence or science based. You’ve made clear that you don’t think it’s necessary to provide evidence to show effectiveness. You don’t use science to discover what’s true, you do it to satisfy the scientific faithful. Rae, you don’t understand what science is and why one would choose it instead of something else. It has nothing to do with faith. Faith is unreliable.

        How can a patient of yours be reasonably assured that any treatment intervention you suggest is safe and effective? Why shouldn’t they expect that what you do has the same scientific support as what their MD’s do? Why integrate a weaker part into the system? You want to be treated as a legitimate health professional without having to prove a single thing. This is utterly unacceptable.

        I wouldn’t buy a toaster with the kind of evidence you say should be sufficient. I like to know my toasters work.

        This post was about the quality of naturopathic education. I think that we can conclude that their education is woefully inadequate if even the fact that patients want proof isn’t understood and valued.

        Also – Your vaccine claim is outrageously wrong. Why should I or anyone else pay you for medical care, when you’re so fundamentally misinformed?

  20. “Mike says:
    September 21, 2011 at 12:24 pm

    I still don’t see the difference between the two. Isn’t ongoing research also used to determine the safety and effectiveness of vaccines?

    Why is it that drug companies need protection against spurious claims related to vaccines but not against spurious claims related to other products?

    What I take from your comment is that you’re implying that vaccines are so important that we must change the rules and instead have the government assume accountability for any misrepresentation of safety or effectiveness when it relates to vaccines.”

    In my opinion, vaccines do deserve special treatment. It is only vaccines that have the power to prevent epidemics which have the capability to decimate populations.

    If a vaccine is determined to be ineffective or unsafe, it will be found out and public health authorities and physicians will cease using it. Whether or not a lawsuit results from that, or where liability lies is a separate issue.

    • Mike says:

      Hi John,

      I guess when it comes to your original comment of :

      ”The difference with science-based medicine is that the unethical tricks employed by pharmaceutical companies are eventually exposed, and are then dropped, often resulting in law-suits. However, ultimately there is accountability.”

      It implies that the end user should feel somewhat protected in the fact that the company in question would be extremely hesitant to engage in such practices since it would be held liable if such unethical behavior was discovered (Vioxx being an example, as you pointed out, with Merck paying out billions in compensation for knowingly misrepresenting and failing to disclose important safety information about the drug).

      But in fact your comment above should have an asterisk next to it stating: *except as it relates to vaccinations.

      And to some, the special treatment for vaccines is justified. And to others, it’s a source of concern.

      • Mike says:

        Hi Kim,

        I didn’t make the comment that Scott refers to above, but since you’re waiting for someone to provide an example of a vaccine being approved for use without proper trials, the flu vaccine for pregnant women is an example.

        The CDC recommends that everyone over the age of 6 months receives this shot every year, and especially recommends it for children and pregnant women. Here are some direct quotes from the Flulaval product insert from GKS.

        “there have been no controlled trials adequately demonstrating a decrease in influenza disease after vaccination with FLULAVAL”

        “Safety and effectiveness of FLULAVAL have not been established in pregnant women, nursing mothers, or children.”

        “A reproductive and developmental toxicity study has been performed in female rats……. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, FLULAVAL should be given to a pregnant woman only if clearly needed.“

      • Kim Hebert says:

        Mike try to look past your myopia on vaccines to see the context of the thread, which is about naturopathy. I asked a question several times about evidence within naturopathy which has still not received a response. That is what I am waiting for.

      • Mike says:

        Indeed. How myopic of me to take a manufacturer’s insert information at face value.

        The placement of your ‘crickets’ comment makes it look like it was in reference to Scott’s comment about clinical trials. I guess Scott and I both owe you an apology for missing the context of the thread.

      • Kim Hebert says:

        Mike, I do not want to get into yet another vaccine debate with you, particularly given that this is not what the thread is about. But if you would like some reading materials on the matter of vaccine safety in pregnant women, here:

        See this review on flu vaccine safety: http://www.ncbi.nlm.nih.gov/pubmed/19850275 There is plenty of sound clinical reasoning for giving flu shots to pregnant women.

        There has been no demonstrated risk of harm for the flu vaccine in pregnant women (the information you referred to even says that), but the flu is quite risky: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-6/index-eng.php#toc4 I think it’s fair to say the risk assessment here is in favour of getting the shot.

        Sick Kids also recommends vaccination, as there is no evidence of harm from the vaccine: http://www.motherisk.org/prof/updatesDetail.jsp?content_id=356

        You are not taking relative risk into account and you have confused general recommendations with specific recommendations. In any case, this is not a thread about vaccines. Please get back on track or take this to a more appropriate thread.

      • Mike says:

        For someone who doesn’t want to get into a debate about vaccines, you sure sound like someone who wants to get into a debate about vaccines.

        One would think that a statement like “there have been no controlled trials adequately demonstrating a decrease in influenza disease after vaccination with FLULAVAL” would make the absence of evidence of harm completely irrelevant.

        But you’re right. I guess I am just confused.

      • Scott Gavura says:

        Mike, the influenza vaccine is considered safe and is recommended in pregnancy. FLULAVAL has been studied in clinical trials, as the monograph notes. Including pregnant women in pre-licensing trials is an methodologic and bioethical issue for all drugs, not just vaccines. Here’s some excerpts from the FDA’s guidance to manufacturers on this issue:

        “During clinical development of most vaccines not specifically intended for use during pregnancy, pregnant women are ineligible to participate in clinical trials. If pregnancy occurs during a study, treatment is usually discontinued and the woman does not receive additional immunizations. Consequently, there are few clinical data to address developmental toxicity of the vaccine in pregnant women or females of childbearing potential at the time of product licensure.”

        So what do they suggest?

        “…we, FDA, recommend that you address during the IND studies the risks versus the benefits of immunization programs for pregnant women and/or females of childbearing potential by performing developmental toxicity studies in animal models.”

        Which is what was done, also as detailed in the product monograph (See 8.1).

        Inclusion of pregnant women (or even women of childbearing age) in clinical trials for any drug, not just vaccines, is an interesting topic that is probably worthy of its own post sometime. Research Ethics Boards grapple with this issue routinely when reviewing clinical trial protocols.

        With respect to this thread, I’m still waiting for evidence to back up the claim from Rae that most vaccines have been approved without clinical trial. Having looked at the prescribing information for the example you provided, we can cross FLULAVAL off that list.

      • Mike says:

        Hi Scott,

        Your comment begins with “the influenza vaccine is considered safe and is recommended in pregnancy.” Page 1 of the insert (highlights of prescribing information) states “Safety and effectiveness of FLULAVAL have not been established in pregnant women”

        I’m sure you can agree that what I’m pointing out to you appears to be a major contradiction. You can spin it any way you want, but it looks pretty blatant to me. At least you only referred to the shot as being ‘safe’ as opposed to ‘safe and effective’. I’m assuming that was on purpose.

        Regarding the FDA’s recommendations regarding pregnant women, thanks for pointing that out. I was not aware of that issue. So it appears that pretty much every vaccine that gets administered to pregnant women is in the same boat as flulaval. Is there a similar ethical issue with including children in clinical trials?

        In your opinion, flulaval should be crossed off the list since the manufacturer is simply following the FDA’s recommendations. In my opinion, not only does flulaval remain on the list, but every vaccine that routinely gets administered to pregnant women joins it on the list. And if there is a similar recommendation from the FDA about not including children in pre-licencing trials, then the list grows even more.

        Sounds like you’ve pretty much answered Rae’s question yourself.

      • SVM says:

        Mike, in pregnancy, it’s imperative to do a risk-benefit analysis when it comes to using any medication in pregnancy. Given that pregnant women are at a higher risk for influenza infections – which in turn results in a higher risk to the fetus – the benefits of the vaccination far outweigh any potential risks.

      • Mike says:

        Hi SVM,

        ‘The benefits outweigh the risks’ is the standard response to any question about vaccine policy. And it’s one thing to make that argument when talking about vaccinating for deadly childhood illnesses. But the flu shot is not the same thing.

        Regarding the benefits of the flu shot, are you saying that if everyone in North America were to get a flu shot tomorrow, that nobody would get the flu this year? You can read through the Cochrane reviews on the effectiveness (or lack thereof) of the flu shot at preventing flu and its complications. You can also read through this link to see a review of influenza vaccine policy vs available evidence:

        http://www.bmj.com/content/333/7574/912.full

        Regarding the safety (i.e. risk) of the flu shot for pregnant women, trials are not done, and instead the manufacturer relies on this, (from the flulaval insert):

        “GlaxoSmithKline maintains a surveillance registry to collect data on pregnancy outcomes and newborn health status outcomes following vaccination with FLULAVAL during pregnancy. Women who receive FLULAVAL during pregnancy should be encouraged to contact GlaxoSmithKline directly or their healthcare provider should contact GlaxoSmithKline by calling 1-888-452-9622.”

        Is every pregnant woman getting a flu shot contacting GSK or being registered by their healthcare provider? Similarly, if a pregnant woman gets a flu shot and then has a child that a year later is diagnosed with a neurodevelopmental problem, is this mom phoning GSK to let them know? Here’s another excerpt from the flulaval insert. It’s a recommendation to the person administering the injection:

        “Patient Counseling Information: Inform the vaccine recipient or guardian that safety and efficacy have not been established in pregnant women. Register women who receive FLULAVAL while pregnant in the pregnancy registry by calling 1-888-452-9622.”

        Is that what health care providers do, or do they simply tell pregnant women, “Don’t worry. We know it’s safe. Ignore what the package says”.

        Health care providers instead rely on ‘the absence of evidence of harm’ as a way to bypass the fact that they have no evidence to gauge the actual safety of the shot. I guess evidence of harm would be women going to their doctors and reporting something bad happening after the shot? Of course, when that does happen, we all know what health care providers think of moms who claim bad things happened after a vaccine.

        When it comes to a risk-benefit analysis of the flu shot as it pertains to pregnant women, the evidence suggests there is little to no benefit and that the risks are largely unknown. As the author of the BMJ article points out, there is a huge gap between flu shot policy and the supposed evidence it’s based on. It’s a prime example of where ‘evidence based medicine’ is not always based on sound evidence.

  21. gmcevoy says:

    funny how proponents of $CAM always talk as though anyone rightly skeptical of this malarkey masquerading as medicine know nothing of the quackery in question

    the entrance requirements are a red herring when the curricula consist of moxibustion and homeopathy amongst like minded vitalistic buffoonery

    And lets not forget Rochoutas, responsible for the 2nd Year curriculum at their Hogwarts in Toronto, laughing at the very idea of homeopathy – lumping it in with crystal healing and chiropracty – on the Michael Coren show in June of 2010(?)

    He was on with some other quack to speak about $CAM, but when that got uncomfortable, they moved the GPs to naturopathy

    When that too, caused discomfort, the GPs moved to we can only speak for ourselves

    They both laughed along with Coren at homeopathy

  22. Mike – what does your misunderstanding of the safety of vaccines have to do with the total lack of efficacy for naturopathic medicines? Even if you were somehow able to prove the lack of safety for vaccines, something researchers for many years have failed to do, that would say absolutely nothing about the ability of naturopathic to provide any benefits to anyone.

    • Mike says:

      Hi John,

      I’m not saying it’s unsafe for pregnant women to get a flu shot. I’m saying the evidence to suggest it is safe is not available. So unless there is clear cut proof that flu shots prevent illness and complications, it’s irresponsible to be recommending that all pregnant women get this shot. And that’s essentially what the manufacturer of the product is also saying. But if you go to your local pharmacist, they’ll tell you to ignore what’s on the label.

      If you read through the Cochrane reviews on influenza vaccine you’ll also find that there’s a direct correlation between the group responsible for funding a particular study and the study’s outcome, which highlights another drawback of the ‘evidence based’ approach.

      NDs can defend themselves. I don’t need to do it for them. But as for minimizing the chances of getting the flu, an MD would highly recommend the flu shot, whereas an ND would have a different recommendation. Your implication is that one should always trust their MD because their recommendations will be based on sound evidence. I’m simply pointing out a situation where that is not the case.

      • Steve Thoms says:

        “But if you go to your local pharmacist, they’ll tell you to ignore what’s on the label.”

        Odd, I’ve never heard a pharmacist tell me to ignore whats on the label, ever. I wonder what our own pharmacist, Scott, thinks of your claim.

        Mike, I’ll kindly ask and remind you to stay on discussion. This article is about naturopath education, and the word “vaccine” was not mentioned in the article, even once, and you were the first person to bring it up. Please stay on task.

      • Steve Thoms says:

        Correction: I mistakenly said you were the one who brought up vaccines. My bad, and my apologies.

  23. Abber says:

    Thank you John for writing this post, which has spawned a lively discussion.

    The regulation of naturopaths may be considered a good thing to some, but I fear it gives them a credibility they do not deserve. They may spend years studying some good science, but they’re also learning some blatantly ridiculous things and should not be given the right to use the term doctor. This elevates them to a trusted status they simply do not deserve and consequently gives credibility to such practices as shamanic healing, neurolinguistic programming and homeopathy, for which there is no evidence of efficacy. This can do harm by steering people away from the therapies and medicines that actually have a proven track record of working.

  24. gmcevoy says:

    ND = NOT a DOCTOR

  25. Paul says:

    I have often wondered at the particular interest that self identified sceptics have taken in homeopathy ( which does seem to be one of the major bones of contention here). The main points being that 1) homeopathy is implausible and 2) homeopathy has no robust evidence.

    1) is easily refuted by robust evidence ( since of course if something works, then it is plausible, whether we think it is or not)

    That leaves us with 2). A quick pubmed search will determine that indeed there is a great deal of published research on homeopathy, much of which is positive in nature ( ie type `homeopathy in vitro`in pubmed, quite fascinating)

    Of the metaanalyses, several have been done, most notably by shane et all in 2005. Previous ones having mixed results and insufficent data to make conclusions. Shane did reach a negative conclusion on homeopathic efficacy, but most remarkably did not release which trials he used for analysis. Upon contact, he continued to refuse disclosure of this to peter fisher, a homeopathic physician in england.

    Most interestingly at all, fisher did eventually reconstruct the analysis in absentia, achieving remarkable insight. It turns out, that thhe actual metanalysis included a set of data from a trial preformed in a rather poorly designed trial ( by fisher himself, how delcious!). removed, the metanalysis showed a greater than placebo effect for homeopathic treatment. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1375230/?tool=pubmed

    The shoddy stats of this paper was noted by other researchers, for separate statistical reasons as well. http://www.ncbi.nlm.nih.gov/pubmed/18834714

    There is positive evidence for homeopathy. It may not be perfect, but it exists. Research is being done. I`m at a loss as to where the ideas of homeopathys impossiblility emerge from with such evidence available.

    • Kim Hebert says:

      I’m confident that nobody literally meant that there is NO evidence for homeopathy in existence. The problem is that the evidence that does exist is of poor quality and is insufficient to prove efficacy, let alone mechanism (which also would require throwing out basic proven concepts from chemistry, physics, biology, etc and replacing them with evidence-based explanations – again, for which, there is insufficient research). It’s more precise to say that there is no GOOD science for homeopathy.

      Homeopathy is not physiologically defensible and hasn’t demonstrated efficacy above placebo in properly controlled trials. For more information, see my evidence summary here: http://www.skepticnorth.com/2010/08/evidence-check-bryce-wylde’s-21-favourite-papers/

      • Paul says:

        Yes I have read that post. And homeopathy has demonstrated efficacy above placebo. In the first link in my post above, with methodologically imperfect trials removed, shangs metaanalysis’ results supported the conclusion that homeopathy was greater than placebo, as well as in numerous smaller scale studies, and the recently improved method, based on benevinistes work.

        I dont care if homeopathy is physiologically defensible within the current models of physiology. If it is a demonstrable effect ( as is certainly arguable from the research data) , then something is happening, regardless of whether something is defensible or not.

        The question is whther the effect is real or not. Not whether the effect fits within current ideas of physiology ( not that they should be thrown out if proven incomplete however).

    • Steve Thoms says:

      Paul: The odd meta-analysis here and there does not amount to a robust body of evidence. I think you’ll find that supporters (and sellers) of Homeopathy often cite meta-analysis studies and are at a loss as to why people aren’t convinced by them. Meta-analysis studies are always circumspect at best, because they cull data from different sources, which use different data-gathering techniques, and control for different variables.

      Then you cited that there were numerous other small-scale studies (link?) that showed positive effects better then placebo. This is dubious as well because small-scale studies mean nothing if they report small effects in small numbers. If you can’t scale them up, they’re meaningless.
      I want to see 4 things in the homeopathy body of literature:

      1) Large Scale studies: Studying the effects of homeopathy in 30 people over a 6 month period is nothing. I want to see several thousand, over the course of several years, properly controlled for age, socio-economic status, existing health conditions etc… A meta-analysis looking at the results of drastically different experiments is not terribly convincing.
      2) Published in reputable journals: Not in homeopath, or CAM journals who stand to gain from positive results, and are notorious for publishing positive results for every CAM modality that comes their way.
      3) Repeatability: Set up the experiments so that the effects can be repeated, and then repeat them, many, many times.
      4) Statistical significance: a 5% better effect then placebo is nothing.
      The best that homeopathy supporters can come up with are poorly-designed studies, published in homeopathy journals, small effects on the small scale, or meta-analysis written by homeopaths.

      This is not convincing.

      The admittedly side-issue of the physical impossibility of homeopathy is no small matter: If homeopathy is legit, then *all* of physics, chemistry, biology and mathematics would be overturned. Instantly. We need a *very* convincing robust body of literature. We need a great deal more then you’re offering.

      By the way, Beneviniste was placed under strict blinding controls by a team from Nature. He failed, and when he was exposed, he acted like the victim (though perhaps “baby” would be a better description). He was caught cheating, and made a stink about it. Beneviniste was a fraud, and he improved no methods.

      • paul says:

        Oh yes I realise that aspect of benevinistes work, that it replicability was low. That is why I stated the IMPROVED methology of benevinistes work.http://www.ncbi.nlm.nih.gov/pubmed/19945674

        I seem to recall another skeptical blogger criticising the controls in this article for having idential responsiveness to any stimulation, and therefore that the whole experiment was wonky. That isnt actually true, the basophils were altered to make them hyperreacive. Thier response was not significantly different with differnt levels of stimulation ( it was just a huge response period) , so the researchers lumped them into one control. This was more reproducible than benevinistes work, but represents an improvement over his methods becuase it treats hyperreactive cells ( in the same way that homeopathics generally dont have an effect on individuals not possesing thier symptom complex)

        I did not say those studies were enough to remove ALL doubt, simply that they should be enough to silence the thunderous pronouncements of homeopathys impossiblility.

        You know I think a great deal of the posters here could benefit froma good course in anthropology ( my field). In such study, we realise that our models of reality are just that, MODELS. They may be well supported by experimentation, and even be actually quite close to reality, but they are still mental constructions.

        As I stated before, there is enough evidence available, of high quality ( I wont site specific papers becuase thay are simply too numerous). Here are a few metanalysis, published in “non homeopathic journals” ( although I dont know why theyre disliked. The homeopath is actually quite good)

        Post surgical recovery:
        http://journals.lww.com/jcge/Abstract/1997/12000/Homeopathy_for_Postoperative_Ileus___A.16.aspx

        Metanalsysi of phsychiatric condidtions:
        http://www.ncbi.nlm.nih.gov/pubmed/21733480

        Another criticque of the shang analysis, stated again that the results are positive with the exclusion of one trial of poor methological quality: http://www.ncbi.nlm.nih.gov/pubmed/18834714

        A metanalysis of 242 children treated double blind for acute diarhea: http://www.ncbi.nlm.nih.gov/pubmed/12634583

        And lastly an interesting article about publication bias in “CAM” journals, suggesting that indeed some bias exists, but it does go both ways here: http://www.ncbi.nlm.nih.gov/pubmed/15955254

        This is not to say negative research doesnt exist. It of course does. Homeopathy is quite difficult to adapt to existing allopathic disease models and research methologies, so man y of these are methodological, and indeed homeopathy is likly to have therapeutic weakeness as any ofther therapy does too. But the research base exists. And if there effect can at least be argued something is happening, regardless of its conformity to our physiological models.

    • Guy Chapman says:

      Skeptics have taken an interest in homeopathy because it has a special status as the last gasp of pre-scientific medicine, and is the easiest to demonstrate to be utterly without merit.

  26. gmcevoy says:

    If homeopathy is a universal thing, if it applies holistically, like biology, chemistry, physics, math

    Why is dilution backwards for C2H5OH? Or coffee for that matter.

    Because those things other than homeopathy explain the phenomena perfectly and consistently.

    Given how shaken water is running across river beds or oceans; how is any water anywhere NOT infused with the alleged molecular memories of anything and everything it has come into contact with for billions of years?

    Or, is it because this shaking must be done in a specific way, preferably on a leather bound Bible as originally prescribed by Hahnemann? This sounds suspiciously like “spectacles, testicles, wallet & watch”. Ritual, not science.

    Because those things other than homeopathy explain the phenomena perfectly and consistently.

    And they don’t support Mr. H at all, any more than Shang et al does, IIRC

    • paul says:

      I challenege anyone to find a field of human endevour without a few bits of superstition in it, should be disavow all surgery becuase early surgeons said a hail mary before operations? ( and indeed I dont think homeopathic pharmacists do that anymore, the volumes they produce are quite large, and their cost in bibles would be astronomical, Its just good buisness :)

      And yes, homeopathy does have very profound implications for the physical sciences if founfd to be legitimate. But again, we cant argue from a conclusion here. If homeopathy has an effect ( which can be argued quite well with research data) then X, Y, Z. We cant argue backwards that if homeopathy were true, water would remeber being dinosaur pee and therefore it is impossible. BAD ARGUEMENT. Maybe water does remeber being in dinosaur pee, and thats the way its always been and our bodys and life systems simply adapt to it.

      Again, if there is an effect, and it can be repeatably demonstrated ( which seems to me like an arguement can be made for this) then there is an effect, regardless of the implications.

      However one might consider the issue of homeopathic pharmacy for insight into this. One of the researchers I listened too hypothesized that the shaking process somehow synchronised the water ( or alcohol) together, erasing former “imprints” ( lets call them) and replacing them with one new one, that of the remedy in question. This does in fact cooincide with the clinical observation of many homeopaths ( whom I’ve studied as an anthropologist) that water remedies do actually ” lose thier charge” over time, if not regularily shaken.

      Completely unproven and untested, but certainly worth considering. It suggests that while water has a memeory, its a relatively short term one, and that the problems of coming into contact with every substance water ever has can be avoided.

      • Dianne Sousa says:

        Paul,

        You seem to miss the point. Naturopaths practice as medical professionals. They are paid to treat people’s medical problems. They use homeopathy as a treatment intervention for sick people. They are paid to treat sick people homepathically Many sell homeopathic remedies out of their own offices.

        You’re defending naturopaths using an unproven, implausible treatment intervention with sick people in exchange for payment. They have a responsibility to ensure that the services they provide to patients work.

        Continue to dance around what really matters here, desperate to eek out any meager possibility that homeopathy will one day be shown to work. In the meantime, sick people will be unfairly fleeced out of money, time, and health on the promise that proof is forthcoming.

        You should have more concern and respect for the victims here.

      • paul says:

        And Diane, you are missing the point of my prior arguements. Evidence for a homeopathic effect exists. Not in as robust a form as we might like, but it exists, and is replicable. Methodologically correct trials are increasing in frequency and indeed showing positive results.

        Implausible does not factor into that, I would like a basic admittance from this group. ” If this effect is shown to be present, there is something to this ultramolecular buisness, its implausibility aside”.

        I am defending homeopathic medicine because I have observed its efficacy 1st hand, and backed that up with a research search for methodologically acceptable studies, in vitro and review. This evidence has convinced me that there is a greater than placebo effect.

        By proxy I am defending Naturopaths who use homeopathy because I am defending homeopathy.

        The other issues you mention are somewhat editorial, and indeed have no place in a discussion of the merits of homeopathy and naturopathic medicine.

        Victims? Really? People making a healthcare choice that suits them based on incomplete data and their own ideas of what constitutes proper treatment are victims? People are capable of making rational choices. Even in terms of their own healthcare

        And indeed, in my observations, I noted people recieving no benefit, while not a huge percentage ( 10-15% in good practitioners) did tend to go elsewhere eventually. They were in it for the results, and if not forthcoming, looked elsewhere. Thats the evidence based medicine most people go after, and to be blunt, if a practitioner can deliver on that, they are hardly victimizing people. That is uncalled for.

    • paul says:

      Oh yes, and I forgot to mention in my post above. Incomplete information is simply the state we live in, If anyone knows someone who makes decisions based on complete information. I’d like to meet them! None of us have all the data, there is a component of belief, and cognitive mapping to every decision, regardless of the amount of evidence used in making it. Again this is not to ay that we should forgo evidence becuase of this, but to deny it would be foolisher still.

      • Dianne Sousa says:

        Paul,

        Naturopaths claim what they do is evidence based. They say that they have proof (i.e. complete data) that homeopathy works. This is the justification for providing homeopathic care to patients. However, if the data is incomplete then naturopaths violate a patients right to informed consent. Not exactly something they can defend.

        Naturopaths should not be free to profit from unproven treatments. I think most are deluded and misinformed, but because they are styling themselves as health professionals they bear the responsibility for their claims.

        I see in your comments another example of someone wanting it both ways. On the one hand, you claim there is scientific evidence for homeopathy, and on the other you say that patients aren’t concerned about that kind of evidence anyway. So I wonder why then you need good scientific evidence in the first place? Your rational patient doesn’t need it to assess whether the money they’re considering spending on naturopathic treatment might be wasted?

        I wonder how a test of that idea would fare in court – say a class action lawsuit?

      • Kim Hebert says:

        Paul, I want to propose a hypothetical situation. Let’s say I claim that there is a teapot in orbit around the sun. Let’s say I find some dubious evidence (say an image that hasn’t been independently verified) of this teapot and, with this evidence, I convince a large amount of people that this teapot exists. Let’s also assume that scientists are rightfully skeptical of the existence of this teapot (who put it there? How does it survive in space without getting shattered? How are we sure what we’re detecting is a teapot and not something else? Etc) and they ask for better proof. My response to this is “well, you can’t prove there ISN’T a teapot there and I have evidence so the teapot must exist” and I conclude that these people are just biased deniers. Why can’t they understand that I have proof?

        Paul, I want you to prove to me 100% that the silly space teapot doesn’t exist. But of course that is an unreasonable request.

        You can prove that the teapot’s existence is highly improbable using scientific reasoning, but you can’t prove that it doesn’t exist. Why? Even though I have insufficient proof of my claim, it’s essentially impossible to prove a negative. Once an idea is in the public zeitgeist, it’s hard to remove because of the very nature of how evidence works. However, we can use the lack of supporting evidence for the original claim, the lack of prior plausibility for the claim, and the poor quality of the evidence to conclude that the claim is not accurate and we can then reasonably require that extraordinary proof would be required to change this conclusion.

        Homeopathy proponents are taking advantage of the nature of evidence to try to boost their legitimacy. Homeopathy is no more convincing than a teapot in space. This isn’t denial, this is a reasonable scientific conclusion given the circumstances that would be applied to any similarly-situated claim.

    • paul says:

      Diane. I did not giving a value judgement about patients seeking out care based on other factors than those most valued by researchers, or implying that somehow this legitimized naturopathic medicine or homeopathy. I merely asserted that such people are active participant, and do indeed have the agency to make such choices and are thus not victims. I meant no comment that this somehow reflects on the validity of those therapies in that comment in particular.

      I certainly do not want it both ways. I have a firm basis in empirical evidence and research for my conclusions, as demonstrated above. Indeed one can always wish for more evidence, and the factor of doubt remains, but sufficient evidence to at least hold the question that something is happening with homeopathy exists.

      The issue of its use in clinic then become one of outcomes. Would one use homeopathy in place of reasonably effective treatments in allopathic medicine ( say for ALL for example). Not a good idea. But as an adjunct to such treatment? Or for treatments in which allopathic medicine is not terribly effective ( mild to moderate depression for example, for which some good evidence exists, in the mental health paper I posted above). What then? It is my estimation that those treatment options are ethically sound, and indeed my observation that this is how most naturopathic physicians and homeopaths practice.

      You seem like an intelligent person diane. I think you can do better than use straw man arguements against me.

      I simply tire of people citing ad infinitum the implausibiltiy arguement without actually reviewing and looking at the research. Not an evidence based approach if you ask me.

      • paul says:

        And Kim. Thanks, thats a much better argument than those that have been so far advanced. And indeed, in such a case the conclusion would have to be that the likelihood of such a teapot existing was small.

        However I too would propose a scenario. Let us say that current astronomical equipment was designed in a certain way to detect certain effects, lets say from comets, and was not particularly well suited to the detection of teapots.

        Let us say you altered the methodology of such astronomical equiptment to make it more suited to the detection of teapots. Let us say your detection rate increased considerably when this occured. I would have to state that the likelihood of your teapot existing would be greatly increased. Eventually with such methodogies the burden of proof could be reached to allow us to firmly conclude the teapot exists, if the results held up.

        A similar issue faces us in homeopathic ( and indeed CAM) research in general. The tendancy of many early studies is to be designed by MDS, with all the models of health and disease associated therewith ( medical anthropology is a fascinating field by the way, I highly recommend its study for ALL health professionals). In other words they are used as drugs to treat diseases as defined by allopathic medicine. I am not commenting here on the validity of allopathic medical catagories, by the way.

        Homeopathy doesnt work this way. It has a different system of evaluations. When that system is applied ( ie the treatment is individualized homeopathy with consultation vs placebo), the rate of positive results tends to improve considerably. This in fact was the issue with the shang metaanalysis. Remove the poor quality remedy y for condition x study, and it becomes statisically possible to claim homeopathy has effects greater than placebo.

        Do you follow me

      • Kim Hebert says:

        Either science can measure homeopathy or it can’t. You can’t have it both ways: citing positive studies and yet claiming that negative results or conclusions of improbability are due to a lack of competent measures. That is cherry picking based on confirmation bias and is not an objective analysis based on a firm understanding of the scientific method.

        You must be willing to consider the null hypothesis that homeopathy doesn’t work, otherwise you are not participating in objective scientific discourse, you are proselytizing. The burden of proof is on homeopaths. I will change my mind about homeopathy if presented with appropriate objective evidence. So far I haven’t been presented with adequate evidence that I would expect of anything else, only logical fallacies and anecdotal evidence that could be attributed to placebo effects or regression to the mean.

        There is no reason for me to give homeopathy special treatment and accept less robust evidence than I would any other health claim. Just like there is no reason for an astronomer to believe me when I say there’s a teapot in space without the same level of proof they would require of any other discovery. The burden of proof would be rightfully on me to give enough evidence to reject the null hypothesis that there is no teapot.

      • paul says:

        Hi Kim. Again I did not say homeopathy cannot be measured by science. I said it must be measured in methodologically appropriate ways.

        Let us say for a moment that we were doing some research on the responsiveness patients to a drug for chronic kidney failure. Lets say instead of basing the drug dosing on a measure of kidney faliure, we based it on a more indirect measure, such as plasma vitamin d, rather than on gfr. Lets say that this study was unsuccessful. Does that mean this drug was neccesarily without efficacy?

        This is a similar methodological error to ” remedy x for disease y” studies. Homeopathy isnt applied this way, and doesnt work this way. Studying it this way is simply methodologically incorrect. Negative results are expected from this lack of appropriate investigation. I dont know about you guys, but the final words of my stats class: “Garbage in, garbage out!”

        I have considered the null hypothesis ( and still do, quite frequently). But it is not advocating for the loosening of scientific rigor to demand that a subject be examined appropriately.

        And again, I do not care if something violates laws of chemisty, physics etc. If it occurs, then it doesnt violate those laws, while it may violate our own fallible human models of them. This data is present, and gradually increasing. This alone should at least allow a measure of respect for those who hold the opinion that there is value in responsible homeopathic practice.

  27. Mike says:

    Quoting John Underhay on Sept 15th: “I will …. suggest that you do some research, focusing primarily on reviews and meta-analyses rather than individual studies to examine the actual efficacy and safety of the treatments. Unless you are prepared to examine the experimental model and critique the statistics and conclusions, individual studies can be very misleading.

    Quoting Steve Thoms on Sept 28th: “Meta-analysis studies are always circumspect at best, because they cull data from different sources, which use different data-gathering techniques, and control for different variables.”

    Yet another problem with insisting that the ‘evidence based’ approach is the only one with merit is that even its proponents have difficulty agreeing on what constitutes ‘good’ evidence.

    • paul says:

      Indeed mike. Research methodology is heavily influential in research conclusions. Please see my post about teapots just above!

      • Just a few points:
        Any study that claims that ‘individualized homeopathy” works better than a placebo, cannot, by definition, be a ‘double blinded study’ a high possibility of bias is introduced.

        Most of the studies you have linked to have merely suggested a small increase over placebo in homeopathic studies.

        It can be cliche to quote David Hume “A wise man, therefore, proportions his belief to the evidence”, but it does apply here. The suggestion that homeopathy works is on very shaky ground, given the implausibility based upon our current understanding of physics. I think much better proof would need to be required for an ethical recommendation for treatments.

        A quick look at a couple of your references above:
        http://www.ncbi.nlm.nih.gov/pubmed/21733480
        The results show a possible effect for fibromyalgia and chronic fatigue syndrome, two disorders that have symptoms with a naturally high variability and no effect in the others studied.

        In the review of publication bias, http://www.ncbi.nlm.nih.gov/pubmed/15955254
        the difference in the publication negative results is higher in non-CAM journals and is blamed, at least in part, on bias in those journals. It is perhaps at least as likely that the higher number of positive results in CAM journals is the result of publication bias.

        I do think that most skeptics would be convinced if a solid enough proof can be provided. We are a long way from that proof today. It seems, however, that supporters of all forms of CAM, just dig in when presented with negative results.

  28. gmcevoy says:

    “I challenege anyone to find a field of human endevour without a few bits of superstition in it, should be disavow all surgery becuase early surgeons said a hail mary before operations? ( and indeed I dont think homeopathic pharmacists do that anymore,…”

    I would hazard there are surgeons today who still pray before they cut.

    But it isn’t a necessary component of the procedure and has nil effect on any outcome. The inventor of homeopathy says it is required for the thing to work…

    Regardless, if the very profitable Boiron isn’t required to use a Bible for the shaking (I wonder how that was determined since the scientific method can’t properly measure this thing.)

    Then, the idea of the short term memory of water needing a regular shaking to keep up the charge certainly does support dinosaur pee.

    Water is constantly shaking all over is it not? How long must it remain still to lose the charge?

    A 200C(K) dilution of fermented duck heart and liver will only prevent the pockets of the snake oil masters from being empty, not the flu.

    The beaker has been cleaned long before the second to last shake down, sterile once more (or very nearly so depending on the H2O).

    At least snake oil may have had some snake in it.

    Why do homeopathic principles not apply to beer?

    • paul says:

      gc, I have read the organon, and while it is ponderous, and I may very well be missing a footnote or something, nowhere do I recall hahnehman stating you needed to beat the remedy against a bible or book.

      Secondly I would ask yo uwhat opion the homeopaths themselves hold about this. Do they hold some completely distorted bview of the world where less is more, etc.

      No, they generally file homeopathic effects as something separate from and differnt than regular chemistry. Beer and so forth dont fall into the homeopathic domain.

      Indeed all valid questions about the memory of water hypothesis. Solution: figuring out an experimental model and using it. The in vitro homeopathic models now poular might be quite lovely for this.
      http://www.ncbi.nlm.nih.gov/pubmed/20043074
      http://www.ncbi.nlm.nih.gov/pubmed/20043074

      • gmcevoy says:

        perhaps not required but Mr. H is said to have used one

        I GoogleU’d this idea and found things like

        “Was Moses the first Homeopath?” WTF?

        also this – http://arcanum.ca/2011/02/10/what-is-a-remedy/

        “While he was still in the realm of chemical science, he found himself diluting and succussing; pounding the bottle lightly against a surface like the palm of your hand (Hahnemann used a leather-bound Bible) in order to invigorate the solution with the force of dynamization. This latter action being very important as it imbued the water with an energetic impulse mimicked in nature called the vortex. This is the way energy travels naturally, imbibed with radial and spherical forces.”

        See the bold faced bit? The rest of the paragraph completely contradicts it.

        It is gibberish, word salad, entirely outside the realm of chemical science and in the realm of

        Isengard

        So which is it? You say homeoquackery is something separate from the chemistry of beer – AKA the realm of special pleading – and this holistic site (with a W, so cute) says ya, beer and homeoquackery both chemical science.

        As a holistic site, I assume they mean this is universally applied. And like all else, homeoquackish things are derived from the chemistry of a sun and the elements it creates in its lifespan that eventually found their way here to make this planet and the things on it.

        The same chemistry that allows us to make beer. And makes duck hearts and livers.

        So if I follow the Korsakov method to the letter with a litre of beer to a dilution of 200C, I end up rinsing out the glass.

        Yet somehow, duck heart and liver treated the same way makes a more powerful melange than the original fermented goop? And this clear liquid, for it will be as clear as that produced when using beer, is good for the flu?

        Yet homeopathy is beyond this ken and hardly seems holistic at all.

        At least when it isn’t, or is, isn’t it?

  29. gmcevoy says:

    “Research methodology is heavily influential in research conclusions. Please see my post about teapots just above!”

    Here’s an analysis of Shang et als meta of homeopathy – http://www.anthromed.org/UploadedDocuments/LuedtkeRuttenJCE08.pdf – interestingly it seeks to refute “Shang’s negative results”

    Here’s the conflict of interest disclaimer:

    “We declare that we have no financial conflicts of interests
    in connection with this article. R Lu¨dtke works for
    an independent non-profit foundation which is dedicated
    to research funding in homeopathy
    . Lex Rutten is a homeopathic doctor.”

    nope, only their jobs depend on homeopathy

    • paul says:

      Is it a conflict of interest for medical doctors to write the shang analysis, comparing the efficacy of allopathic medicine to homeopathy. Is it ethical for the gay judge to declare prop * unconstituional.

      yes, If something is correct, it is correct, whether it is a homeopath or a voodoo priestess who says it.

  30. “Is it a conflict of interest for medical doctors to write the shang analysis, comparing the efficacy of allopathic medicine to homeopathy.”

    “Is it ethical for the gay judge to declare prop * unconstituional.”
    It makes no difference. Would it be ethical for a straight judge to declare it constitutional? The question is: is the decision sound?

    The issue above was that the authors (Ludkedo and Rutten) do not see their own conflict of interests. It is tantamount to saying I stand to make money off of a particular result, but I have no conflict of interest. That is the definition of C of I. The only interest science based doctors have is in patient protection.

    On the question of the inability of the current scientific method to detect the efficacy of homeopathy, what model would you suggest that would be better?

    • paul says:

      Pel, is this in any way different than what I stated. If the metaanalysis is flawed, then it is flawed, regardless of who did the pointing out of the flaws. I notice that you didnt actually address the actual criticism. Is it valid? Nevermind who raised it. Is there something to it?

      Homeopaths too are capable of impartial analysis. Is there is a statistical flaw in their reasoning, point it out and be done with it. There is not need to criticize thier perceptions of what constitutes a conflict of interest.

      I did not state the inability of science to detect homeopathic effects. I stated that the commonly applied methodology is not appropriate to measure homeopathic effects. Remedy x for disease Y doesnt work. there isnt really a corespondance in terms of disease catagories. What does work to a greater extent are properly designed in vitro studies, and finding an objective measure and applying individualized placebo controlled double blind treatment, allowing for the normal process of prescription refinement that occurs in homeopathy ( often the prescription is changed after the 1st and second visit into a better fitting remedy).

      Please do not twist my words. I argued that appropriately designed science CAN measure homeopathy. but that poorly designed science showing no efficacy is proof of nothing!

      • You tried to imply that a non-homeopath would be biased based upon that alone. I pointed out that the authors of the paper do not understand the concept of conflict of interest. That is a separate issue from the validity of the analysis. However, conflicts of that nature automatically require greater scrutiny of the results.

        Your description of a method of evaluating homeopathy is absolutely useless. You cannot ‘tweak’ a treatment in a blinded study,never mind double blind.

        The simple fact is, appropriately designed studies developed to measure the effects of homeopathy and acupuncture have shown no difference from placebo.

        I am not twisting your words, you are doing that yourself.

      • paul says:

        tweak the study design, not the study itself. That is not a challenging concept. I would not measure blood pressure with a telescope. You do not measure things with studies unsuited to them, It is foolish. And to be blunt, if this is a point of so much contention, being such a basic issue in clinical research, I have great doubts about the basic understanding of research in this forum.

      • paul says:

        And it is not a conflict of interest for researchers to comment on a subject with which they are familiar. Yes, homeopaths think homeopathy is efficacious. Is thier analysis flawed? That is the SOLE question upon which its evaluation should stand. It is bias beyond bias to suggest otherwise.

      • Art Tricque says:

        Paul: “You do not measure things with studies unsuited to them, It (sic) is foolish.” Homeopathy *conveniently* claims that it cannot be measured by the scientific method, only with methods that have been shown to be flawed and as a counter to which the scientific method evolved. It is a simple choice: either homeopathy gets on the bandwagon and conducts rigorous medico-scientific research, or it will continue to be consigned here and elsewhere to the pre-scientific rubbish heap of fables that modern society thankfully has discarded.

      • Art Tricque says:

        Paul (Sept. 20, 10:58 PM): “And it is not a conflict of interest for researchers to comment on a subject with which they are familiar. Yes, homeopaths think homeopathy is efficacious. Is thier (sic) analysis flawed? That is the SOLE question upon which its evaluation should stand. It is bias beyond bias to suggest otherwise.” Please make sure to read peicurmudgeon’s comments. He said (Sept. 30, 10:23 PM): “You tried to imply that a non-homeopath would be biased based upon that alone. I pointed out that the authors of the paper do not understand the concept of conflict of interest. That is a separate issue from the validity of the analysis. However, conflicts of that nature automatically require greater scrutiny of the results.(my emphasis added) Your response is a non sequitur: it is a conflict of interest for research into homeopathy to be conducted only by homeopaths from sample populations drawn only from the homepathic-believing community and published only in homeopathic journals (I exaggerate slightly to make the point clear). This COI does not a priori trash any results obtained or conclusions drawn. However, it does mean that any research so conducted should be scrutinized more carefully than otherwise. This is exactly peicurmudgeon’s point. I will add that the same applies to other similar COIs like research into a new drug performed by a drug company.

  31. gmcevoy says:

    actually the Shang analysis looked at the quality of homeopathic studies

    and found them lacking – small samples, poor design & control – and any left showed placebo

    i was recently in a RCT and i’m very happy i didn’t get the homeopathi sugar pills

    • paul says:

      No it didnt. The shang metaanalysis stated (in the abstract I might add) that 19% of homeopathic trials were of high quality, and that 8% of allopathic trials were of high quality. This was an extensive search at the time, and contained most of the placebo contolled trials upto that point.

      Fascinating that homeopathy had higher quality trials then randomly selected allopathic match trials. Not that this is truely representative of the literaure, but still interesting.
      http://www.ncbi.nlm.nih.gov/pubmed/16125589

      Youre statement is wrong. either through ignorance or deception. That is in no way acceptable in an honest disscussion of the merits of any therapy. Is an honest discussion what we are having? Becuase if this is simply a ” sceptical” Koombaya well then, forgive me for disrupting it with evidence.

  32. gmcevoy says:

    So 19 outta 100 were high quality for homeoquackery vs 8 for medicine?

    All that shows is people are doing iffy studies all around – at least in regards to whatever mode of treatment was being studied.

    I welcomed this news in regards to medicine when I read it few years ago – it means the method is working, not that the method cannot measure.

    A poor study is a poor study, poor enough and the results are so suspect as to be useless – whether positive or negative aboot the thing under study.

    I don’t yet know the results of the RCT I was in, but I can tell you that if I just happen to be one of the lucky ones and this stuff isn’t much better than placebo, it shouldn’t be used. Not. Worth. It. The kind folks running it are of the same opinion.

    Lucky as in cured though, not just treatment/suppression of symptoms as is so often trotted oot. Underlying cause isolated and eliminated.

    Zo, less than one in five high quality studies for homeoquackery vs less than one in ten for medicine. 19/100 and 8/100

    Or is it? from your link:

    “When the analysis was restricted to large trials of higher quality, the odds ratio was 0.88 (95% CI 0.65-1.19) for homeopathy (eight trials) and 0.58 (0.39-0.85) for conventional medicine (six trials).”

    Now it is eight for sugar pills and six for medicine. .8 and .6 8/100, 6/100

    Hardly a fascinating difference at all and avoids the conclusion of Shang’s meta analysis, again from your link:

    “Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.”

    Shang et al actually comes down to:

    1: Less than 1 in 10 high quality studies of homeoquackery

    2: homeoquackery is placebo as shown by these studies

    now I said:

    actually the Shang analysis looked at the quality of homeopathic studies and found them lacking – small samples, poor design & control – and any left showed placebo

    As I had mentioned, I read this several years ago.

    It would seem my recollection of a past reading, did I mention it was several years ago, far more accurately describes the findings of Shang – 92/100 studies lacked and were tossed; 8/100 show placebo – than your current misrepresentation of the same evidence.

    That I forgot the medicinal aspect of Shang is understandable given that I expect and want this kind of analysis – looks like this stuff doesn’t work, let’s move on. Oh, and I read it several years ago, not just before posting.

    That memory slip doesn’t in any way alter the negative evidence for homeoquackery presented by Shang.

    And I’m being deceptive or ignorant?

    Honesty hardly seems your strong suit.

    Cherry picking however…

  33. gmcevoy says:

    no blockquote? :(

    Damn you preview button! Where are are you when we need you?

    That memory slip doesn’t in any way alter the negative evidence for homeoquackery presented by Shang

    should end with

    and paraphrased by me, quite accurately I must say, after having read it several years ago.

    • paul says:

      gm, did you read the statistical refutations of shang presented above? Shang is not a valid metanalysis becuase some of its constituent data is not methodologically valid. The old axiom in stats proves correct ” garbage in, garbage out”

      • gmcevoy says:

        but Bryce Wylde has Shang et al listed on his website as one of his favourite studies in support of homeoquackery

        “Shang is not a valid metanalysis becuase some of its constituent data is not methodologically valid.”

        Oh, so now Shang’s not valid. earlier it showed a measurable effect.

        How do you keep track of your lies?

  34. Dianne Sousa says:

    Paul just nailed it with his comment above:

    Naturopathy Education in Canada – Garbage In, Garbage Out.

    Keep reaching for that non-existent teapot in the sky.

  35. Art Tricque says:

    To the Skeptic North management team: I would love to point out the serious flaws that commenter Mike has made about vaccines, but respect the desire to not have the comments attached to this article, where they are off topic. Please post a new article soon about vaccines — perhaps this year’s flu vaccine composition could be a place to start — so that the logical and factual errors of Mike’s arguments can be addressed. They need to be so that the casual reader (in particular pregnant women) is not mislead.

  36. Wyandotte says:

    My complaint about naturopaths is that they are way too much like medical doctors, at least the younger ones. You go in there with your symptoms and there’s better than a 50% chance you’ll get a neutriceutical, which is a substance that behaves like a drug, only you don’t need a prescription from an MD. So many of them don’t look for deep, fundamental causes any more and their treatments are equally shallow.

    The old timey naturopathic style of medical treatment (prior to 1950s) had central organizing principles.

    No wonder people go to places like “curezone” on the internet. Sift through their terabytes of info and you may find something that will truly help you, unlike MDs, homeopaths or Naturopaths. It’s the only place I’ve ever gotten useful advice.

  37. MichaelE says:

    Sadly, “accredited-conventional” brick and mortar schools are so incredibly expensive that fewer and fewer people can afford them without going into serious debt. Therefore, many become ignorant and write articles about subjects they do not understand.

    After receiving my MA in a regionally accredited university and waisting way too much money and sitting through numerous courses with brainless professors, I decided that my next level of education would be on-line with colleges that offered exactly the curriculum I needed at prices I could afford. Who cares if a school is “accredited”? I certainly don’t anymore. Accreditation usually ups the price X5, which is exactly what happened to a “natural health” scool that became accredited. What’s more important is the education. Just because a school is “non-accredited”, doen’t mean a degree from them is any less satisfactory than the others.

    What’s important is to remember that “natural” health, herbology, homeopathy, nutritional therapies, etc came BEFORE mainstream drug-empowered medicine, and there were many more cures and less diseases than are created my the promoters of “modern” medicine. If today’s mainstream medical schools were legitimate, why in the world do so few teach ANY courses in nutrition? Case closed.

    • Accreditation usually ups the price X5, which is exactly what happened to a “natural health” scool that became accredited. What’s more important is the education. Just because a school is “non-accredited”, doen’t mean a degree from them is any less satisfactory than the others.

      What is different about accredited schools is the consistency. We can generally assume that a professional educated at one school has had a very similar education to someone in another. We do not have that without the accreditation. Think about driving over a bridge designed by an engineer who did not receive his education from an accredited school. As far as CAM schools, of course, it really makes no difference. We know from research that ‘sham’ acupuncture works as well as ‘real’ acupuncture, so it doesn’t matter which you learn.

      What’s important is to remember that “natural” health, herbology, homeopathy, nutritional therapies, etc came BEFORE mainstream drug-empowered medicine, and there were many more cures and less diseases than are created my the promoters of “modern” medicine. If today’s mainstream medical schools were legitimate, why in the world do so few teach ANY courses in nutrition?

      Less diseases (I assume you mean ‘fewer)? What dreamworld are you living in? There is no logic in the concept that older=better. Or that the number of cures=better. Treatments work or they don’t; they are more or less effective. Age has nothing to do with it. I think you will find that nutrition is taught at medical school, although there is a debate about the appropriate amount. On the other hand, there are professionals educated at accredited schools known as dieticians who are very well trained in nutrition. You will find dieticians employed in many areas of modern health care. In CAM, you will find nutritionists, who are not professionals, and often educated in non-accredited schools providing advice that may or may not be grounded in research.

      Case Closed

      Yes—but not in your favour.

  38. gmcevoy says:

    funny, I watched a show on the 5000 year old “Ice Man” found in the Alps

    He had a full stomach when he was likely murdered by one of his own tribe – ibex meat, nuts and grains

    also he had genetic markers for heart disease

    and arteriosclerosis

    yep, earlier equals better alright and we were all organic vegans

  39. Michel says:

    “You cannot opt in and out of science as you please. If you buy into the idea that there is no objective reality and therefore science is only one way to know things, you leave yourself saying things that contradict each other. Worse, you don’t seem to recognize that this is what you’re doing. You have no consistent standard of evidence.” -Dianne Sousa-

    This is extremely well put.

  40. sara says:

    What a very useless article written by a very closed minded individual.

    Sad indeed.

  41. Watson says:

    After failing on Imuran, Prednisone, 6MP, and finally Remicade, my Homeopathic Doc put me into remission (2 plus years now) …. I guess you have the right to be wrong hey buddy?

    • We will all be wrong, whether we have a right to be or not. However, we are much more likely to be wrong if we rely on anecdotal evidence for our medical treatments; Especially our own anecdotes.

      I am pleased that you are into remission and I hope your good health continues. If your disease returns, I hope you return to your oncologist. That is where your best hope lies.

  42. If you wrote something that cannot be supported by facts or statics, please say what you think it is.This was an extensive search at the time, and contained most of the placebo contolled trials upto that point

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  • John Underhay

    John Underhay, also known as Peicurmudgeon, is just your average atheist, left leaning, SCUBA diving, snorkeling, biker. He lives on PEI and spends some of his time attempting to point out the flaws and or dangers in promoting ideas that run contrary to the laws of physics, chemistry, or biology. He has a BSc (Biology) and an MSc (Pharmacology) from the University of Prince Edward Island, and is currently retired. You can read more of his posts at http://peicurmudgeon.wordpress.com/