(Photo by monkeywing.)
The College of Physicians and Surgeons of Ontario (CPSO) has drawn criticism recently for their bizarrely-worded policy proposal regarding alternative medicine, most notably from the Canadian Medical Association (general organization feedback here). Common concerns were that the policy is insufficiently objective and science-based, does not adequately address patient protection and physician liability/COI (conflicts of interest), and unjustifiably undermines science-based medical practices for the sake of incorporating modalities that are popular, yet functionally ineffective. This if of great concern to public safety, especially considering an apparent lack of ethical priorities (blank since at least October 2009) and the risk of alternative product manufacturers not adhering to established health and safety rules (for example, see this story from Australia).
A letter to the editor recently published in Allergy, Asthma, & Clinical Immunology further justifies recent concern over alternative medicine practices. In their review of 53 Alberta and BC naturopathic clinic websites for science-based health modalities, authors Timothy Caulfield and Christen Rachul found that the most popularized treatments are not scientifically-defensible, as they have not been objectively and consistently demonstrated to work beyond placebo. Their conclusion:
“A review of the therapies advertised on the websites of clinics offering naturopathic treatments does not support the proposition that naturopathic medicine is a science and evidence-based practice.”
The survey showed that among the top promoted interventions were questionable modalities like homeopathy, chelation, acupuncture, hydrotherapy, and chiropractic and among the top ailments treated were allergies, subjective issues such as pain and fatigue, women’s health issues such as menopause and fertility, digestive issues, etc (see Table 1). Also on the list were progressive conditions such as autoimmune diseases and cancer. Clinical nutrition was on the list of top offered interventions, however this is not alternative when based on good science. Lifestyle counseling was also on the intervention list, which may or may not be alternative depending on what is counseled and, based on naturopaths’ interaction with the scientific community, there is good reason to believe that people who see naturopaths may not be receiving good counsel.
For example, we have seen in the Skeptic North comments (most recently here) that at least some promoters of naturopathy do not appear to possess basic knowledge of the scientific method or the skill of critical appraisal of scientific literature. Looking through the comments, one can see anecdotes confused for evidence (no word on who counts the negative outcomes or who measures against placebo and regression to the mean), cherry picking of evidence among claims of scientific insufficiency to study naturopathic modalities (one comment even implied that naturopathy studies are merely used to appease those who do value science), accusations of bias at the same time as painting the scientific community as bigots who push toxic drugs on an unsuspecting public, equating helpful intent with actual valuable help, likening scientific consensus to “opinion”, anti-immunization sentiments, etc.
Absent from the comments: A professional response to a basic level of criticism that is fundamental to all scientific fields, with adequately appraised evidence of the treatments that were under criticism in the original post.
This is not to single out naturopaths as scientifically-illiterate, as plenty of people are unfortunately not skilled in critical appraisal, no matter what health field they are in. This is a concern among all health professions, but science-based health professions have a scientific framework to help steer them in the right direction. This framework is apparently absent from naturopathy if, for example, homeopathy is still a primary remedy.
Naturopaths’ understanding of science is of particular concern because recent provincial legislation has allowed them to position themselves as primary care practitioners. However, kind ears and unproven modalities do not a health field make, no matter what appeals are made to popularity. Without some objective reasoning to justify treatments and “advice” (such as delaying or abstaining from immunizations), patients are at risk of harm regardless of what benefit was intended.
Naturopaths can be quick to point out shortcomings in standard medical care when criticized, rather than directly and adequately addressing the criticism. The authors explain why this is a significant issue:
There is no doubt that other healthcare professionals, including physicians, provide therapies that are not supported by solid empirical evidence. And a wide range of social forces, including a pervasive industry bias, often distorts the evidence that is used . These are serious problems, for sure. But the evidence issues of the medical profession cannot, obviously, stand as a justification for not using evidence in the context of naturopaths. All healthcare options should, as much as possible, be informed by good science . To this end, the medical profession has a stated commitment to evidence-based practice and is taking steps to deal with the deficits in the production and use of evidence. As evidence improves, new practices are adopted and those shown to be ineffective are dropped.
In other words, two wrongs don’t make a right.
Change, when appropriate as determined by evidence, is important for progress. To that end, the authors ask:
If the naturopathic medicine were truly “science based”, as so often claimed by the advocates of the field, would they still be providing homeopathy as one of their core treatments? Would chelation and colon cleanses be marketed on so many of the clinics’ websites?
If naturopathy is to be taken seriously in the health community, proponents must do more than merely pay lip service to science, wielding low-quality studies like shields. Participating in science is more than using the words of science to bolster legitimacy, it is participating in the peer review process and adequately addressing criticism so the field can progress with the evidence. Currently, naturopathy appears rooted in ineffective modalities that are long in tooth and short on benefit with so far no indication that this attitude intends to change.