Respectful Insolence

I’ve lost track of how many times over the last 7 years I’ve mentioned that naturopathy is not science-based. The evidence is overwhelming. All you have to do is to took at the wide variety of quackery that fits comfortably into naturopathic practice to realize that most of naturopathy is quackery. Traditional Chinese medicine? Check. Various “energy healing”? Check. “Detoxification” woo? Check. Homeopathy?

Check.

I brought up this point last year when I pointed out that you can’t have naturopathy without homeopathy. I based this assessment on the fact that not only his homeopathy a required part of the curriculum of naturopathic schools, but it’s also part of the naturopathic examination known as the Naturopathic Physicians Licensing Examinations (NPLEX), which is required for licensure in the states that have made the mistake of allowing licensure of naturopaths. Basically, naturopathy is, as I’ve characterized it before, a hodge-podge of unscientific treatment modalities based on vitalism and other prescientific notions of disease, sometimes sprinkled with the occasional bit of science-based recommendations, like trying to put a bit of powdered sugar on a rat turd. Basically, naturopaths “pick one from column A and one from column B” when it comes to pseudoscience, mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine. Meanwhile, the leadership of naturopathy in the U.S. tries to represent naturopathy as scientific, with hilarious results.

Yes, the very leadership of naturopathy in the U.S. not only defends homeopathy, but now, again on the official blog of the American Association of Naturopathic Physicians (AANP), it’s lamenting that homeopathy is “dead” in a post entitled, appropriate enough, Why is Homeopathy Dead? To add to the naturopathic cred of this article, it’s written by Shiva Barton, ND, LAc, who is the 2011 AANP Physician of the Year and apparently a big fan of homeopathy. Barton is very, very unhappy at how homeopathy is taught and used by most naturopaths. Now, normally you might think this is a good thing. Maybe naturopaths are actually figuring out that homeopathy, which is based on prescientific vitalism and sympathetic magic and, as a result, postulates that “like cures like” and that diluting (and succussing) a remedy to the point where not even a single molecule is likely to remain unless it’s a contaminant, is one of the most blatant forms of quackery there is.

Nope:

Despite what they may have heard about me, I have quite a few naturopathic students and young doctors that visit my office. My most recent visitor was Dr. Laura Chan, a recent graduate of Bastyr U, a smart, dedicated and enthusiastic new practitioner. She is excited, dedicated and enthusiastic about almost all the aspects of being a practitioner as she embarks on her new career. One of the things she was most notably not enthusiastic or excited about was homeopathy. Dr. Chan was interested in homeopathy when she first arrived at Bastyr. However, her training in homeopathy led her to believe that homeopathy was too complicated to use as a treatment modality in a general naturopathic practice. Now, I would like to think that Dr. Chan’s experience was an anomaly, but it is not. Almost all of the students that I have been a preceptor for, no matter the college, have had an experience like Dr. Chan. So my question is, “What’s up with the way the ND schools are teaching homeopathy?”

So, according to this student, the problem with homeopathy is not that it is a fetid, stinking pile of pseudoscientific nonsense mixed with prescientific vitalism and magical thinking. Oh, no. The problem with homeopathy according to this naturopathy student is that it’s too complicated! And Barton agrees, leveling this withering criticism not at the fact that homeopathy is even taught and required at all in naturopathic schools but at how it’s taught:

Is this the idea, then, that the only way you can do homeopathy is to do classical prescribing? Homeopathy, evidently, is a very serious endeavor. It seems like the version that is taught in the ND medical colleges is something similar to the following:

  1. You have to take a 1.5 – 2 hour intake and get every minute detail to be effective.
  2. Homeopathy doesn’t mix well. You can only prescribe a homeopathic remedy. You can’t mix it with other treatments because:
    a. The other stuff messes up the homeo.
    b. You can’t tell what is working if you give homeo with something else.
  3. You have to wait a month to see if it works (this alone is a good strategy for unemployment and/or starvation of the practitioner).
  4. You can really do incredible, irreparable harm to a person’s vital force if you pick the wrong remedy. I mean, we are not just talking about vital force, for gosh sakes. We are talking about VITAL FORCE here. You don’t want to screw with someone’s VITAL FORCE, do you?

So, the combo platter of taking too long, waiting too long, too much danger, too little income and too many rules scares people from using homeopathy in their practice.

Barton owes me a new keyboard for that bit, because I laughed so hard when I read it that I spit up some of my coffee. Seriously? “You don’t want to screw with someone’s VITAL FORCE, do you?” Pure comedy gold! The reason that academic naturopaths (an oxymoron if ever there was one) in schools of naturopathy downplay homeopathy is because it messes with the vital force too much? Almost as amusing is the part about how you have to wait too long to see if it works, and that’s a good way for a newly minted naturopath to go out of business in a hurry because patient’s won’t wait that long. If ever there were an admission that one reason homeopathic remedies appear to work is because users mistake regression to the mean for real improvement, I haven’t seen it. It’s also fairly ironic that the reality of practice affects naturopaths as much as anyone else. They can’t afford to spend two hours on a new patient intake any more than most physicians. Oddly enough, occasionally, I do not infrequently spend two hours with a new breast cancer patient (well, maybe not two hours, but definitely an hour). I’m not sure I could do that if I were in private practice.

So what’s Barton’s solution? He tells newbie naturopaths to try “homeo” (which is how he abbreviates the word “homeopathy”) but to “throw out the homeo philosophy books (really!) and stick to the basics: match the remedy to the person with the symptoms.” Interesting. Does Barton mean that doing the full homeopathic consultation doesn’t “match the remedy to the person with symptoms”? Even more interesting, I thought that homeopathy, naturopathy, and all those “natural” treatments were supposedly superior to boring old science-based medicine because (as naturopaths and other alternative practitioners tell us time and time again) it treats the cause, not the symptoms, of disease. Yet, here Barton is explicitly telling newbie naturopaths to match their homeopathic remedies not to the disease itself but to the patient with the symptoms.

Barton then explicitly refutes each of the four objections to homeopathy he listed above. He tells us that, yes, it is possible to do homeopathy with only a one hour consultation. Personally, I bet after learning a few homeopathic remedies that I could do a homeopathic consultation in about 15 minutes, prescribe a few sugar pills from which the water has been evaporated (which, let’s face it, is what most homeopathic remedy pills are, given that there is no active ingredient left in the water added to the sugar to make the pills), and get results as good as any naturopath. It is fortunate indeed that I have not turned to the Dark Side. Think of the havoc I could wreak! Alas, my sense of morality and ethics prevents me.

Barton’s next recommendation is that naturopaths not only can use other remedies with homeopathy but that they should use other remedies with homeopathy because homeopathy won’t interfere with other remedies and vice-versa. This one point I’ll have to concede. Given that in most homeopathic remedies (and pretty much all such remedies above 12C or so) there is no active ingredient left and all you’re left with is water or sugar pills from which the water containing nothing has evaporated, Barton is actually right here. Most homeopathic remedies should not interfere with real medicine, unless, of course, they happen to be one of those homeopathic remedies adulterated with real drugs or contaminated with heavy metals, in which case, look out! In any case, Barton also claims that homeopathy works very quickly, “acutely within hours and chronically within a day or two,” and that “nothing else generally works this fast.” Placebo effects, anyone? Finally, according to Barton, homeopathic remedies can have side effects (one wonders what) but that these side effects are “generally fewer and less intense than from other treatments.” No doubt, given that homeopathy is nothing more than magic water.

When I first saw a title of a post on the official blog of the AANP asking why homeopathy was dead, I briefly had a ray of hope that maybe—just maybe—naturopaths were finally coming around to realize that, from a scientific and clinical viewpoint, homeopathy is quackery. I’ve argued before that naturopaths cannot call themselves scientific as long as they embrace the thermonuclear woo that is homeopathy to the point where they teach it in every school of naturopathy and even require a certain “competence” in it as measured by a licensing examination. What “competence” means in a field that is vitalism, pseudoscience, and magical thinking, I don’t know; I’d love to see the NPLEX to see what sorts of questions are there. In any case, it’s clear that if the AANP keeps posting stuff like this, American naturopaths are showing no signs of abandoning quackery.

Comments

  1. #1 Tony Mach
    June 7, 2012

    The believe in all that “natural healing” woo is so strong in so many humans, that I suspect that it must have served an evolutionary benefit. Nevermind that it is no longer an advantage today, but understanding how this susceptibility to woo-believes has arisen and what evolutionary purpose it once served might be helpful in overcoming it – or at least to use it to everyone’s advantage.

  2. #2 Denice Walter
    June 7, 2012

    The money quote is that homeopathy takes too long and provides too little income. That’s his real objection.

    TCM, energy healing and de-tox can be much easier to manage and can be universally applied, less need for protracted Q & A sessions.. There are lists of ready-made TCM formulae, energy healing is basically laying-on-of-hands and de-tox can be administered by pill or gallons of green juices. Easy to write that rx.

    To be perfectly frank, from reading/ hearing the usual swill I survey, I think that I could provide a reasonably good facsimile of facsimile doctoring ( not that I would, I’m sarcastic, not crazy) by understanding what (fictional) relationships exists between particular symptoms and illness and particular herbs and supplements ( in their fevered imaginations). So if someone has arthritis they would prescribe several herbs ( and spices), supplements and perhaps green juices. For depression: St John’s Wort, 5-htp, niacin. Believe me, they have lists of remedies that consist of products they already sell.
    -btw- *SHIVA* Barton?

  3. #3 Eric Lund
    June 7, 2012

    You can’t tell what is working if you give homeo with something else.

    What Barton can do is listen to me playing the world’s smallest violin.

    Many patients will have more than one thing wrong with them, e.g., a cold along with whatever longer-term complaint they have. Does Barton honestly expect a patient not to try to self-medicate for that cold while trying to deal with the longer-term issue? If he does, I have a special deal for him on a bridge linking Brooklyn and Manhattan. The best a doctor can do is advise the patient to avoid certain types of remedies because they might interfere with their other medication. Human nature is to try to do something to feel better.

    Not to mention that many instances where homeopathy appears to work are exactly this scenario: the patient takes both the homeopathic remedy and some other remedy, and it is actually the latter (or a placebo effect) which relieves the symptom.

  4. #4 lilady
    June 7, 2012

    “I’ve argued before that naturopaths cannot call themselves scientific as long as they embrace the thermonuclear woo that is homeopathy to the point where they teach it in every school of naturopathy and even require a certain “competence” in it as measured by a licensing examination. What “competence” means in a field that is vitalism, pseudoscience, and magical thinking, I don’t know; I’d love to see the NPLEX to see what sorts of questions are there. In any case, it’s clear that if the AANP keeps posting stuff like this, American naturopaths are showing no signs of abandoning quackery.”

    Orac, naturopaths still are embracing homeopathy treatments. Here’s the link for the header page for sample questions that appear on the NPLEX “licensing” exam:

    http://www.flashcardexchange.com/tag/nplex

    Scrolling down to the homeopathy medicine NPLEX sample questions, we see four sections devoted to homeopathic medicines and the clinical indications for prescribing each of them:

    http://www.flashcardexchange.com/cards/homeopathy-mm-264351

  5. #5 Calli Arcale
    June 7, 2012

    Tony — absolutely there is an evolutionary reason why humans are prone to woo. I don’t think it’s that woo is advantageous; on the contrary, I think it’s a predictable outcome of several key elements of our particular brand of intelligence, all of which are extremely valuable for other reasons. Humans learn extremely quickly, a trait which makes us good hunters and gatherers, but also makes us highly adaptable and able to pass pretty sophisticated lessons on to our offspring and others in our community, enabling our society-level behaviors to change far more rapidly that mere genetic evolution could achieve. Without this trait, we could not possibly have achieved the global dominance that we, alone of all primates, have achieved. Our vast learning capability hinges on both a heightened sense of pattern-seeking and also a social drive to learn from other humans and to share what we have learned *with* other humans (which aids not only the dissemination of language but also the creation of culture, a crucial element in building complex civilizations). Without this, we would probably now be extinct, along with all the other hominids. One downside of it is that in order to be such fast, keen learners, we take shortcuts, and are excessively motivated to find answers. This can definitely lead us astray. But it will lead us the right way often enough to be a huge advantage over other animals. It leads us to invent things like homeopathy but also things like the Internet. I’m not a fan of woo, but if that’s the price we pay for rapid advancement, it’s probably worth it from an evolutionary perspective.

  6. #6 D
    June 7, 2012

    Don’t want to mess with the VITAL FORCE!

    That is comedy gold!! I love that more than I can say. Wow.

  7. #7 Denice Walter
    June 7, 2012

    If you want to see how human associative memory often leads to people believing in unrealistic causal links based on contiguity, read about the experiences of mothers trying out various woo-drenched ‘therapies’ @ TMR or AoA: if they give a new supplement or diet and observe speech or whatever else they’re trying to promote in their children, they assume that the new treatment *caused* it.

    See also ‘superstitious pigeons’.

  8. #8 Ren
    Corner of 1st and Amistad
    June 7, 2012

    Hey, hey, now… Easy with the naturopaths. I once had a cold for four days before I went to one who gave me a homeopathic remedy. The cold disappeared two days later, as if by magic.

    (See what I did there?)

  9. #9 Heliantus
    June 7, 2012

    it’s too complicated

    Yeah, all of these modalities and illnesses to learn about, it’s confusing my little brain. Why can’t we have a single cure for everything (a.k.a panacea)? This way we don’t even have to learn how to recognize what ails the patient.

    No seriously Shiva, tell your students to get off their sorry a** and, I don’t know, start studying.
    Oh wait, in order to do this, you need some real science to study.

  10. #10 jrkrideau
    June 7, 2012

    For anyone looking for a new and better vital force cure the BBC’s health check http://www.bbc.co.uk/podcasts/series/healthc had an interesing item about traditional medicine in Ecuador.

  11. #11 dreamer
    June 7, 2012

    Tony and Calli — I’ve been thinking why generally intelligent, well-adjusted people, like my friends, believe in woo.

    Here’s a hypothesis of mine, something a complex psychology /sociology/culture etc study might support (or not)–suppose our planning and acting for the future can be put on an X-axis, with “healthy visualization” at one end and “unrealistic woo” at the other. Is there scientific proof that good planning works well? (I think yes, plenty of anecdotal and science proof of that.) Is there evidence that imagining, visualizing a plan before actually planning works well .. I think so, without a bit of dreaming/planning nothing would ever happen long-term.

    But somewhere on that scale, healthy visualization becomes unrealistic, non-factual, sham, fraud, self-defeating when people really believe in “The Secret,” prayer, woo, etc. Where exactly is that transition point from the positive to the negative side of that X-axis? Is it a point or is it a whole wide region?

    Perhaps us scientifically-minded could have more success in convincing others to look at facts not fiction if we were able to better understand the nuance between a healthy, desirable visualization vs. unfactual, misguided woo.

  12. #12 naturocrit
    June 7, 2012

    Re: “American naturopaths are showing no signs of abandoning quackery”…

    I have a long-standing partial review of naturopathy’s Textbook of Natural Medicine up at Amazon.com (see http://www.amazon.com/review/R3O3Y1LGUXC0Y9/ref=cm_cr_rdp_perm ).

    I must be doing something right when all the naturopathy lovers rate me review 8 out of 100 in terms of being “helpful.”

    Responders haven’t discredited my criticisms, and usually they attack me instead. I put it up years ago yet only recently a rather ‘new’ ND associated with the blood-type diet ND guru D’Adamo engaged in a discussion with me.

    To quote that ND: “‘we hope that the debate will finally move from the question, Does homeopathy work? to the more pressing questions of How does homeopathy work? and What conditions can homeopathy treat effectively and cost-efficiently?’ In sum: just because you don’t understand how something works doesn’t change the fact that it works.'”

    It goes better, with such positions as:

    “as naturopathic physicians, because we are using a cluster of interventions, it doesn’t really matter whether or not one or two of their effects turns out upon further study to be mostly or even wholly placebo (although, the possibility remains the the effects of certain single interventions are only synergistic-and this too should be studied, e.g. does homeopathy increase the efficacy of an otherwise identical protocol?) as long as the weight of all of the interventions is efficacious.”

    -r.c.

  13. #13 Pareidolius
    June 7, 2012

    I left a comment to the article over there at the Bonkersville Daily Gazette. It will be “visible after approval.” That means it will never see the light of day, but at least I tried. Maybe it was the whole Tooth Fairy Science thing . . .

  14. #14 palindrom
    June 7, 2012

    I’m not so concerned with my vital force, Mandrake.

    I’m worried about my …. essence.

  15. #15 lilady
    June 7, 2012

    “A foreign substance is introduced into our precious bodily fluids without the knowledge of the individual, and certainly without any choice. That’s the way your hard-core Commie works. I first became aware of it, Mandrake, during the physical act of love… Yes, a profound sense of fatigue, a feeling of emptiness followed. Luckily I — I was able to interpret these feelings correctly. Loss of essence. I can assure you it has not recurred, Mandrake. Women, er, women sense my power, and they seek the life essence. I do not avoid women, Mandrake…but I do deny them my essence.”

  16. #16 Narad
    June 7, 2012

    -btw- *SHIVA* Barton?

    It appears to actually be Leonard. Bronx High School of Science, class of 1970. One can imagine how such things come about.

  17. #17 Kelly M Bray
    it's foggy and my hovercraft is full of eels.
    June 7, 2012

    @lilady Hahahahah, Kubrick was a genius

  18. #18 bad poet
    June 7, 2012

    Vital force? Essence? Smells like an extremely malevolent case of flatulence to me.

  19. #19 Chemmomo
    Land Without Preview
    June 7, 2012

    I think Shiva Barton, ND, LAc is worth quoting again the next time a homeopath comes here crying Pharma Shills!
    (my emphasis) )

    So, the combo platter of taking too long, waiting too long, too much danger, too little income and too many rules scares people from using homeopathy in their practice.

  20. #20 Prometheus
    On parole from Tartarus
    June 7, 2012

    That was a close one. I very nearly aspirated my soup spoon while reading this:

    “However, her training in homeopathy led her to believe that homeopathy was too complicated to use as a treatment modality in a general naturopathic practice.” [emphasis added]

    Too complicated? Is he serious? You look in the book, find something that matches the patient’s symptoms and give them the sugar pills. Of course, in reality, you could give the patient any homeopathic remedy, since there isn’t any active ingredient in any of them. One vial of shaken water or sugar pills is the same as the next when it comes to homeopathic “remedies”.

    I have long suspected that the people who go to Naturopathy school are those who couldn’t get into either a real medical school or chiropractic school, and this seems to confirm my suspicions.

    I also noted another of my long-held suspicions being confirmed:

    “You have to wait a month to see if it [homeopathy] works…”

    If you treat most self-limited medical problems with a placebo and then wait a month or more for it to resolve, your chance of “success” should be pretty high. And if the problem doesn’t resolve in a month? Well, you might want to seek real medical attention.

    Finally, I’m interested to see that I wasn’t the only one to read “VITAL FORCE” and immediately go to “purity of essence”. The difference between Gen. Jack D. Ripper and a naturopath/homeopath is that Sterling Hayden was only acting irrational (it was in the script).

    Prometheus

  21. #21 lilady
    June 7, 2012

    @ Kelly M. Bray: I think it took me three viewings of Strangelove, to realize that the officious character portrayed by Keenan Wynn, was Colonel “Bat Guano”…

    “Group Capt. Lionel Mandrake: Colonel! Colonel, I must know what you think has been going on here!

    Colonel “Bat” Guano: You wanna know what I think?
    Group Capt. Lionel Mandrake: Yes!

    Colonel “Bat” Guano: I think you’re some kind of deviated prevert. I think General Ripper found out about your preversion, and that you were organizing some kind of mutiny of preverts. Now MOVE!

    Group Capt. Lionel Mandrake: Colonel… that Coca-Cola machine. I want you to shoot the lock off it. There may be some change in there.

    Colonel “Bat” Guano: That’s private property.

    Group Capt. Lionel Mandrake: Colonel! Can you possibly imagine what is going to happen to you, your frame, outlook, way of life, and everything, when they learn that you have obstructed a telephone call to the President of the United States? Can you imagine? Shoot it off! Shoot! With a gun! That’s what the bullets are for, you twit!

    Colonel “Bat” Guano: Okay. I’m gonna get your money for ya. But if you don’t get the President of the United States on that phone, you know what’s gonna happen to you?

    Group Capt. Lionel Mandrake: What?

    Colonel “Bat” Guano: You’re gonna have to answer to the Coca-Cola company.”

  22. #22 herr doktor bimler
    June 7, 2012

    homeopathy was too complicated to use as a treatment modality in a general naturopathic practice

    Prometheus: “You look in the book, find something that matches the patient’s symptoms and give them the sugar pills”

    I was under the impression that we couldn’t run test / control comparisons on homeopathy because the prescription was different for each patient — a unique profile of sugar pills optimised for that patient’s *personal constellation* of dis-ease.
    So there are no precedents to be judged against, and there are no wrong answers; if some other homeopath would have combined a different profile of sugar pills, well both are correct.

    How can you go wrong?

  23. #23 ChrisP
    June 8, 2012

    I agree with Barton about the teaching of homeopathy. They must be teaching homeopathy wrong if the students think it is too complicated to use as a treatment. After all, all the sugar pills are really the same. It doesn’t matter which one you choose. Just make sure the mark, I mean patient, doesn’t know that you don’t know what you are doing. That I understand is the correct approach for a homeopath.

    I suspect Barton has it right about income too. The students should be being taught how to string the patients along, giving them one sugar pill that doesn’t work after another in order to find the right sugar pill. If the student is trying to work out the correct pill to give based on the symptoms and individual nature of the patient, they are doing it all wrong. There is not enough repeat custom in doing that.

    Smart fellow this Shiva Barton.

  24. #24 Narad
    June 8, 2012

    I do find it mildly interesting that Barton tosses the surviving bits of “antidoting” under the bus. (Organon aphorism 260 and footnote are highly recommended.)

  25. #25 Chemmomo
    Land Without Preview
    June 8, 2012

    ChrisP

    The students should be being taught how to string the patients along, giving them one sugar pill that doesn’t work after another in order to find the right sugar pill. If the student is trying to work out the correct pill to give based on the symptoms and individual nature of the patient, they are doing it all wrong

    Based on other discussions on this site with homeopathy defenders (anyone remember Julian?), that’s how I thought it was done. Isn’t that also the chiropractic model?

  26. #26 Mephistopheles O'Brien
    Lucy's Toy Shop
    June 8, 2012

    Talking Naturopath Barbie says, “Homeopathy is hard!”

  27. #27 Marry Me, Mindy
    June 8, 2012

    MOB for the win!

    That goes into the RI-HOF

  28. #28 Denice Walter
    June 8, 2012

    Because we** are currently stranded in the economic doldrums, waiting for either a stiff breeze or a stiff drink,
    I believe that we all could use a laugh, so here goes:

    Julie Obradovic @ AoA discusses bloggers who write critically of AutismOne and MMS ( we may know them) but raves about the wisdom portioned out at said Autism One.

    Today’s entry @ TMR heaps praise upon EFT ( not ETFs)- it’s energy psychology; tap your way to emotional health..

    And last, but certainly not least, MIke Adams teaches us how to spot a sociopath. He should know.

    ** and economies of the English-speaking world are amongst the better-offs.

  29. #29 Alan Kellogg
    At the Opposite End of Another Part of the World
    June 8, 2012

    Here’s something the homeopaths haven’t considered; given that millions of people live at the end of a long pipeline, that all water has been in contact at one time or another with most any molecule you care to name, further that supplies of water have additional water added constantly (thus continually diluting it), and that this water is constantly being shaken and stirred, is it any wonder we have such a healthy population?

    Tap water, it’s good medicine.

  30. #30 Health Care Review
    http://www.goodhealthtipsonline.com
    June 11, 2012

    we are currently stranded in the economic doldrums, waiting for either a stiff breeze or a stiff drink,
    I believe that we all could use a laugh, so here goes:
    I think Shiva Barton, ND, LAc is worth quoting again the next time a homeopath comes here crying Pharma Shills!

  31. […] now. About a year and a half ago, I wrote one of my characteristic Orac-ian screeds describing how you can’t have naturopathy without homeopathy, how homeopathy is a required part of the educational curriculum for naturopaths. It’s […]

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.