A paean to naturopathy on—where else?—The Huffington Post

If you're a skeptic and supporter of science-based medicine (SBM), as I am, no doubt there are times when you ask yourself in exasperation, frustration, or curiosity just what the appeal of quackery is to so many people. Why do people fall for this stuff? you no doubt ask yourself at times. Certainly I do sometimes, and even though I know a lot about the cognitive shortcomings that we humans all share that lead to confirmation bias, confusing correlation with causation, mistaking placebo effects and regression to the mean for real therapeutic effects, and poor observational skills, sometimes these explanations don't seem to be enough, even though I've exhibited some of them myself. Skepticism can reduce the effect of these cognitive quirks on our reasoning, but no human, no matter how steeped in science and skepticism, is completely immune to their effects. Even though I know this, I still sometimes puzzle over what the attraction of something as obviously pseudoscientific as homeopathy is.

That's why I'm always grateful to anyone who can help me understand the reasons why human reasoning goes astray, even if she does so inadvertently. That person might not appreciate the not-so-Respectfully Insolent attention I bring upon her in learning more about the woo mindset, but I don't really care. If you post something on the Internet, it's fair game. You don't see Orac whining when someone who doesn't exactly agree with him decides to try to deconstruct one of his posts (good luck with that!), do you? Of course not. Leaving aside that digression, the latest victim blogger who has inadvertently given me insight into the mind of woo blogs at—where else?—that wretched hive of scum and quackery, The Huffington Post. Meghan Pearson, a blogger who writes about vegan food and—surprise! surprise!—is also a reiki practitioner topics visited a naturopath and decided to blog about it, calling the end product, appropriately enough (for her) My Love Affair With Naturopathy (crossposted to the blog of the naturopath whom Pearson consulted). It is pretty much as bad as you might imagine from that title.

In this post, we learn that Pearson has a variety of health complaints, including a history of bulimia, chronic dry mouth, messed up menstrual cycles, and what she refers to as her "battered" immune system. We also learn that she likes things that are "natural," whatever that means, her implication being that "natural" could somehow help her where she thinks "conventional" medicine has failed:

The thing is though, with all my concern and yearly check-ups, we never really "solved" a thing. Nope, my body is still quite out of whack; my monthly cycle is non-existent without the aid of oral contraceptives, I suffer from chronic dry mouth, and my blood pressure is continuously low. Visit after visit, my doctors of western medicine would listen to my concerns, conduct standard testing procedures, write me a prescription or a requisition for more invasive investigation, and then rush me out the door.

Which led Pearson to decide:

But I have decided that I want answers. Not just band-aid solutions, or easy fixes. With all my nutritional background and knowledge, and my keen interest in Eastern medicinal techniques, I now know that there are options, and that it is a lot simpler to work at preventing illness with lifestyle changes, than it is to try and "fix" disease once it is present.

This is, of course, the false dichotomy that truly drives me crazy. The implicit assumption behind such statements is that somehow naturopaths or other quacks are somehow more "natural" and "holistic" that doctors practicing science- and evidence-based medicine. Yet a good primary care doctor is a holistic doctor and will do what's best for his patient regardless of whether it fits into the false "natural" paradigm peddled by alt-med practitioners. To put it bluntly, you don't have to embrace "natural" quackery to be a holistic doctor, but that's exactly what naturopaths want people to think: That they are more "natural" and "holistic" than those evil, money-obsessed "Western" doctors.

Enter Erin Wiley, the naturopath that Pearson ended up going to see. She practices at the Integrative Health Institute in Toronto. Naturopathy, as I've discussed before, is a grab bag consisting of a mix of treatments and ideas that range from pure quackery to ideas that are potentially reasonable but rendered much less so or completely unreasonable by being quackified. Examples of this latter category include nutrition and exercise, which, in naturopathy world tend to be related to science-based concepts of nutrition and exercise by coincidence only. True to this assessment, Wiley's practice offers:

  • Botanical Medicine
  • Traditional Chinese Medicine (TCM) including acupuncture
  • Strategic Nutritional Supplementation
  • Homeopathy
  • Lifestyle Counseling
  • Detoxification

As I said, a mixture of nonsense and seemingly reasonable treatments. For instance, homeopathy and detoxification are both pure quackery. Homeopathy, as we've discussed so many times before, consists of diluting remedies down to the point where there is not a single molecule of the original compound left. "Detoxification" involves doing all sorts of things to rid the body of vague "toxins" (which, oddly enough, are almost never identified or specified), including but not limited to chelation therapy, colon cleanses, liver flushes, Kinoki footpads, and "detox foot baths." Much of traditional Chinese medicine, while it made sense in a prescientific belief system and in the context of prescientific concepts of disease and how the body works, is in essence vitalism. Speaking of traditional Chinese medicine, Wiley touts Chinese pulse and tongue diagnoses. Tongue diagnosis, as you might recall, involves looking at a person's tongue and mapping different organs and parts of the body to it. As I've discussed before, real doctors do look at patients' tongues in order to make diagnoses. You can actually tell a fair amount about a patient's health by looking in their mouths. Hints in the diagnosis of vitamin deficiencies, amyloidosis, candidiasis, and many other things can be gleaned form taking a close look at the tongue.

This is not what we're talking about when we talk about TCM tongue diagnosis.

In TCM, looking at the tongue can lead to fantastical diagnoses, such as Yin deficiency, heat in the heart, excess heat, deficient heat, blood deficiency, blood stagnation, qi deficiency (one wonders if qi deficiency results from the use of an alien healing machine), yang cold, yin cold, strong excess evil, or weak Zheng Qi. These are not real medical diagnoses, and one of the many reasons naturopaths can't be considered in any way scientific is that TCM is part of its curriculum and used by nearly all naturopaths (well, that and homeopathy, which is just as bad, if not worse). Moreover, tongue diagnosis is such an integral part of TCM that it's not an exaggeration to refer to it as being central to the entire system of medicine.

Pearson was also impressed that apparently this naturopath hooked her up to electrodes and measured a bunch of things about her body, which she described thusly:

We did my body composition test using a series of electrodes attached to a few points of my body, yet another new experience, but I won't have those results until my next visit. Hopefully this can answer, among other things, the question as to whether or not my body is absorbing water into my organs as it should, and then we can figure out if and why I am so bloody thirsty all the time!

I wasn't sure what this was. There are, after all, so many quack devices involving hooking up the patient to electrodes attached to a machine that goes ping, that gives all sorts of scientific-looking but meaningless results. Then I saw on the practice's website just what it probably was that Wiley hooked Pearson up to: A "bioimpedance analysis" (BIA) machine. Now, BIA is a real machine that is sometimes used to estimate the proportion of body fat a patient has and fluid distribution. Another use of BIA is in measuring lymphedema after breast cancer surgery. If that were all that naturopaths used them for, then it might not be so bad, because BIA is a fairly standard way of measuring body fat. However, BIA is advertised for all sorts of conditions. I've seen claims that it can detect breast cancer before mammography, for instance. There is literature on using BIA to characterize cancer, but nothing that justifies claims that it can detect breast cancer so early. Is Wiley using BIA in a manner that measures what science-based medicine concludes that BIA can measure? Maybe. As always, the devil is in the details, and it seems highly unlikely that any BIA can determine whether Pearson is absorbing water into her organs as it should or that it could give any meaningful clues to help figure out why she is thirsty all the time. BIA might not be quackery when used properly, but the "used properly" part is very important. If all Wiley is doing with the results is trying to measure body fat distribution and water distribution, BIA is probably OK. If she's making any claims more than a percent body fat and maybe a statement about edema, then she's going too far. I can't tell for sure which she is doing from Pearson's account.

Perhaps one of the most amusing parts of the article is how blown away Pearson is that the naturopath actually did orthostatics on her. What I mean is that the naturopath took her blood pressure sitting down and standing up because her blood pressure is low (85/50), exulting that her regular GP had never done that before. Of course, if patients have orthostatic symptoms (getting light headed or feeling as though she is going to pass out when rising from a recumbent or sitting position to standing), it's worthwhile to check for orthostatic hypotension. If she is asymptomatic, then most doctor's wouldn't worry much about a blood pressure of 85/50. It's normal. Indeed, blood pressures that low tend to be associated with very healthy athletes. Orthostatic hypotension, of course, can be indicative a of a number of conditions, most commonly simply dehydration, but also certain neurological disorders, as a side effect of certain medications (such as antidepressants), or anything that can leave one dehydrated, such as, yes, bulimia. Then there's Addison's disease, which can also cause orthostatic hypotension and segues right into what Wiley thinks is wrong with Pearson:

So what conclusions did we come to? Well, I just may have a condition caused "adrenal fatigue" brought on by the high levels of stress I have been under over the course of the past few years. Apparently, my poor adrenal glands just aren't functioning as they should, and in turn, a whole slew of other systems in my body are unhappy as well. This might explain the shortness of breath I have been having recently, my fluctuating energy levels, and dry mouth. I love that after just this one sit-down with me, Erin was able to recognize the wide array of symptoms I have, and focus them in on one specific possible cause. Next up: treatment!

I left that day armed with a ton of arsenal to put me on the path to recovery from my tired adrenals, including two recommended botanical supplements. Dr. Wiley also supplied me with a two-page "action plan" of sorts, to get me moving forward in improving my health in a holistic way. This print out serves as a guideline for a few very simple changes I can make to improve my digestive health, kidney function, endocrine balance, and general nutrition, all specific to my personal needs.

"Adrenal fatigue." It had to be "adrenal fatigue." It's a favorite quack diagnosis (just Google it). It's a wastebasket diagnosis for people with symptoms like this:

  1. You feel tired for no reason.
  2. You have trouble getting up in the morning, even when you go to bed at a reasonable hour.
  3. You are feeling rundown or overwhelmed.
  4. You have difficulty bouncing back from stress or illness.
  5. You crave salty and sweet snacks.
  6. You feel more awake, alert and energetic after 6PM than you do all day.

It become clear if you look at a typical diagnostic questionnaire for adrenal fatigue that it's a dubious diagnosis. I took the questionnaire myself, and guess what? According to the questionnaire I have "moderate" adrenal fatigue myself! Get me to a naturopath, STAT, for some diet changes and supplements! Well, not so fast. The Hormone Foundation and The Endocrine Society both point out that adrenal fatigue is a bogus diagnosis. Adrenal insufficiency is a real diagnosis, and, yes, sometimes it's not obvious to diagnose, leading to confusion, but there are definite diagnostic criteria to guide physicians in making it. But "adrenal fatigue" is a nonexistent diagnosis:

  • “Adrenal fatigue” is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms.
  • Adrenal insufficiency is a real disease diagnosed through blood tests.
  • There is no test that can detect adrenal fatigue.
  • Supplements and vitamins made to “treat” adrenal fatigue may not be safe. Taking these supplements when you don’t need them can cause your adrenal glands to stop working and may put your life in danger.

As I mentioned before, the symptoms of "adrenal fatigue" are nonspecific and could be indicative of many different conditions—or nothing at all. One of these days, I'll have to delve more into "adrenal fatigue." I can't believe I haven't done it before after all these years blogging. In the meantime, I'll simply point out that, using the criteria I've been able to find on the web, I'd conclude that nearly everybody suffers from some degree of "adrenal fatigue"; that is, unless one doesn't ever have stress, is always happy, and eats a raw vegan diet, and even then one might still have "mild" adrenal fatigue.

All of which brings us to why naturopaths seem so seductive. People with lots of nonspecific symptoms (sometimes called the "worried well") often don't like it when, after a real doctor tries his best to find out if there is anything wrong that he can treat, they are told that they have no specific disease or anything that can be cured with a pill or specific intervention. So, like Meghan Peary, they trot off in search of someone who can tell them what is wrong with them. Now, sometimes, the original doctor missed something and there really is something wrong with them that another doctor finds. More often, however, there is not. If such patients end up in a naturopath's office, the naturopath will always have one or more of many nonspecific diagnoses like "adrenal fatigue" that have little or no basis in reality to give them. The patient now has an answer and a plan. She is happy. It doesn't matter if that answer is pure pseudoscience and the plan is usually pure quackery or mixes some sensible suggestions with a whole lot of quackery. It's an answer and a plan.

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I know diagnosis by internet can be dangerous and IANAD, but I wonder if Pearson has a hypothalamic disorder caused by her bulimia. It would explain all her symptoms - the thirst, dehydration and low blood pressure due to ADH deficiency, menstrual disorders due to low levels of sex hormones etc.. It's certainly more likely than "adrenal fatigue".

By Krebiozen (not verified) on 09 Nov 2012 #permalink

I can't understand for the life of me why those people claim that naturopath cure them "holistically" and that modern medicine only cater to disease and not to prevention.
I have a family history of cardiac problem and emphysema. When my doc heard it, he told me all about avoiding smoke (I don't smoke), not become obese (I am moderately chubby which is ok) and doing regular exercise to try to minimize my change at getting either disease.

A lot of people are also scared that they results are somewhat up or down the average. I remember a friend of mine (who went to med school) who normally had an hearthbeat of 100 per minute. She had no other symptoms and was completely healthy. She told me she was just made that way. Now, another person might get worked up by that and pretend a diagnosys, when they aren't ill, just different.

Peraphs it is quackery that wants us all the same, and SBM that truly accepts differences (when they aren't a symptom of a disease, of course). I have tought that for a while

Maybe the discussion about orthorexia from the other day is still on my mind, but the fact that she previously had an eating disorder and is still on a very restricted diet (raw vegan) is raising a huge red flag for me. Is it possible that a nutritional deficiency is behind some of her problems? I'd welcome any comments from the more knowledgeable regulars about this.

By Edith Prickly (not verified) on 09 Nov 2012 #permalink

Raw vegan diet? Highly restrictive - and probably prone to nutrient deficiencies.

One thing that is not brought out often enough is the storefront aspect to nearly all naturopaths. They diagnose you with abstract disorders and prescribe supplements and vitamins that, coincidentally, they just happen to have in stock.
If a real medical practitioners tried that, their licences would be forfeit.

By peicurmudgeon (not verified) on 09 Nov 2012 #permalink

Looks like a raw vegan diet is deficient in B12 and low in available iron, calcium, protein and omega-3 fatty acids.

Our omnivorous digestive system is better at absorbing certain nutrients from animal sources.

@ Krebiozen: IANAD either, but that certainly sounds plausible.

By Edith Prickly (not verified) on 09 Nov 2012 #permalink

@peicurmudgeon - yes, exactly. I think it's hilarious that alties are constantly raving about doctors being in cahoots with Big Pharma, yet see no problem with a naturopath diagnosing them with a condition that he/she just happens to sell a treatment for right in the office! When my doctor writes me a prescription I don't pay her for it, I go to a pharmacy of my choice, not hers, and they often give me a cheaper generic version of what she's prescribed. If she's really just in it for the money, this is a very inefficient business model.

By Edith Prickly (not verified) on 09 Nov 2012 #permalink

And licensed falsehood marches on...

-r.c.

By naturocrit (not verified) on 09 Nov 2012 #permalink

@Anj - I skimmed some of her other posts on HuffPo and she mentions being mostly gluten-free as well - there's another restriction. And she actually says here (sorry I have to post the full link, but I have yet to figure out how to do it the other way: http://www.huffingtonpost.ca/meghan-pearson/bulimia_b_2034158.html) that people have raised the issue of whether being a raw vegan is a good idea with her health history, but she thinks she's got it solved. I'm not so certain.

By Edith Prickly (not verified) on 09 Nov 2012 #permalink

So. I just received a bit of a things-falling-into-place shock when reading this. When I was a teenager, I got hit with a bad bout of depression (it runs in the family; a friend of mine had been killed in a car accident; a lot of bad things lined up at a bad time), but I didn't really believe it was depression, so my mom and I headed over to a naturopath to get things sorted out.

And I got diagnosed with adrenal fatigue, and took these stupid plant pills and 'got much better' (coincidentally, still on anti-depressants). But my experience with the naturopath was my jumping off point into a sea of quackery and woo, and it has only been within the past two years that I finally left all of that nonsense behind. It was a struggle, because so much of how I saw myself had to do with my illness and subsequent recovery through 'natural' means.

I've long suspected that my doctor was right in his initial diagnosis and that I was suffering from depression, even if I didn't believe it at the time. However, I had NO idea adrenal fatigue was a common quack diagnosis. And so now all of those little pieces from my teenage years have fallen nicely into place and I can now see what happened to me for what it really was.

I have to say, though, that I feel so incredibly manipulated retrospectively. I was a scared and severely depressed teenage, and this woman, whom I trusted, could have ended up seriously hurting me. And it took me YEARS to get over the brainwashing process she started. I am more than a little furious.

Thank you, as always, for the lucid and pertinent insights.

What makes woo so attractive to people?

I'll try to focus on the emotional aspects:
in short, it makes people feel good. Alt media preaches a system that nearly eliminates chance and ( falsely) empowers its marks into thinking that they have near total control over illness and health.

if you entertain a woo practitioner, he or she will evaluate you and provide solutions without mentioning the problems of side effects. low probablilities or inability to cure. In short, they lie to make you feel better. ( Anyone ever see "The Invention of Lying"?)

Another aspect of this involves breaking free of experts: you suddenly don't need a ( real) doctor to tell you bad news and prescribe uncomfortable treatments- instead, you get what you want without bowing to reality. By following a woo-meister, you become sort of a 'prentice yourself: you can lord it over experts as well. Self- esteem issues vanish like the morning dew as you instruct the heathen.

This aspect may be overlooked: suppose you are a person who aspires to expertise and being gratified by the respect of others but you never manage to make it to through a well-known university or be accepted for further training in medicine or another field.

However, if you set yourself up as a critic armed with a boatload of ersatz degrees and a tarted up CV, you might get like-minded dissatisfied rebels like yourself to help you in your vision quest, ensuring your fame and fortune.

There must be a great deal of envy which I believe comes out nearly undisguised in the anti-SBM rants with which we are all so familiar. Hatred and vile epithets are tossed at anyone who dares criticise a beloved woo-meister or sainted, holy rebel- but you see, these critics usually are also experts -either in medicine, psychology or journalism- thus, not exactly what the naturopathic doctor ordered.

Thus cognitive shortcuts and emotional paybacks help fuel woo- and for alt med providers, fame and fortune enable them, feeding their already well-padded grandiosity.

By Denice Walter (not verified) on 09 Nov 2012 #permalink

Masters of all they survey?

In the wake of economic fiasco, Null and Adams, not content to be known solely as health experts, ventured into new areas of in-expertise: the economy and politics. Over the past several years, they have offered remedies to strengthen fiscal as well as physical health.. and their own interests as well- selling films, books and 'special access' internet ( the Inner Circle @ Natural News) perhaps to make up for supplement sale losses in an economic downturn.
If you peruse their websites, you might be surprised that articles and shows often are more about the economy and revolutionary politics than about pseudo-medicine and useless supplements.
- btw- they certainly hate Mr Obama.( see recent screeds).

Woo-meisters and their devotees exhibit mutual enablement and ego servicing. I know I could call it something else but I won't.

On adrenal 'exhaustion':
interestingly enough, Null's so-called dissertation for his so-called doctorate involved "studying" the effects of chronic caffeine use on the adrenals through erstaz tests ( see Quackwatch's article). He "found" diminished adrenal function that he speculated ( fancied) could be remedied through nutrition and a regime of supplementation. Which he could of course provide all-too-willingly.

By Denice Walter (not verified) on 09 Nov 2012 #permalink

@Anj, et al

I’m not a vegan (just vegetarian) and most vegans I know are not “raw” vegans, although they may have done that as a phase at one time. Most vegans are perfectly healthy either by using B12 supplements or eating the occasional egg or bit of cheese (almost any diet can have occasional exemptions in real life).

Why are omnivores so hell bent on trying to paint people who don’t eat flesh foods (or animal products at all in the case of vegans) as wild-eyed lunatics? Is it so awful to care about animals enough to not eat them?

What to eat (within the limits of adequate nutrition--which does not require flesh) is a philosophical or moral question, not a scientific one and to equate veganism with medical woo is, well, unscientific.

Any registered dietician will work with a vegetarian or even vegan person to achieve a balanced and nutrient-adequate diet. Vegans who ignore science and do not get enough B12 will have problems, but so will flesh eaters who don’t cook their hamburger well enough or simply eat too much and become obese--and while I don’t have data at hand, I’ve never met a fat vegan.

Please don’t conflate diet choice with woo per se--or veganism with vegetarianism.

@JBC

Why are omnivores so hell bent on trying to paint people who don’t eat flesh foods (or animal products at all in the case of vegans) as wild-eyed lunatics?

Perhaps because all too frequently vegans/vegetarians overstate the benefits of a non-meat diet. Barring specific medical diagnoses, the choice is, also, entirely philosophical, and attempting to justify the choice through appeals to objective criteria generally fails, however vehemently the choice is championed.

This is not to say that all vegetarians or vegans are like this, but the more vocal ones do tend to stray into woo-woo territory.

Pearson: "With all my nutritional background and knowledge, and my keen interest in Eastern medicinal techniques"

If I'd been one of her physicians, I would have found it awfully tempting to rush her out the door too. She probably spent most of her office visits telling them what they were doing wrong and what tests she felt were indicated.

I hope the woo pseudo-docs are making enough money to compensate for having to deal with such patients.

By Dangerous Bacon (not verified) on 09 Nov 2012 #permalink

DW, insightful as always

There is a show in Toronto hosted by a self styled intellectual on the Christian Network.

He did a show on alt-med with two skeptics and two naturopaths.

Incredibly, he got the two naturoquacks to throw homeopathy under the bus with chiropractors (host had a bad experience with one) and crystal healers.

One naturoquack, Phillip Rochoutas is the Dean of the 2nd year curriculum at their Hogwarts here in Ontario and they were both laughing it up with the host at the foolishness of homeopathy.

By al kimeea (not verified) on 09 Nov 2012 #permalink

Please don’t conflate diet choice with woo per se–or veganism with vegetarianism.

I'm not. I don't view vegetarianism or veganism as problematic for otherwise healthy people who've made the choice for ethical or health reasons. Eating a healthy diet isn't woo, although woo-sters have co-opted it to give legitimacy to their more dubious recommendations.

However, if you're talking about someone with an eating disorder history who is still eating a highly restricted diet, there is good reason for concern. There was a study published earlier this year in the Journal of the Academy of Nutrition and Dietetics that looked at vegetarianism in women with and without eating disorders and found that in some cases the women who'd had eating disorders were using it as a sort of "cover' for continuing to restrict their eating. http://www.ncbi.nlm.nih.gov/pubmed/22818732

Again, I am ,not saying vegetarian diets per se are unhealthy. But looking at vegetarianism as a panacea - the way a lot of woo-prone people do - is mistaken, and in the case of someone like Ms Pearson who may already have nutrient absorption problems caused by her bulimia, it might be doing more harm than good.

By Edith Prickly (not verified) on 09 Nov 2012 #permalink

I’ve never met a fat vegan.

I know several. Anecdotal yes, but let's not generalize about obesity either.

By Edith Prickly (not verified) on 09 Nov 2012 #permalink

a skinny veggie friend thinks obesity is down to choices the person has made and nothing else

By al kimeea (not verified) on 09 Nov 2012 #permalink

For me, a timely posting by Orac and some excellent comments.

I like this bit very much, DW: so much that it bears repeating, so please forgive the cope & past, but no italics:

"In short, they lie to make you feel better. ( Anyone ever see “The Invention of Lying”?)

Another aspect of this involves breaking free of experts: you suddenly don’t need a ( real) doctor to tell you bad news and prescribe uncomfortable treatments- instead, you get what you want without bowing to reality. By following a woo-meister, you become sort of a ‘prentice yourself: you can lord it over experts as well. Self- esteem issues vanish like the morning dew as you instruct the heathen."

What she said...

Orac, as you well know I post frequently on the Ho-Po...so I posted twice. I went easy on the snark and linked to two articles:

NY Times article about contaminants in vitamins and supplements:

http://www.nytimes.com/2010/05/26/health/policy/26herbal.html

And, regarding "adrenal fatigue", this link:

http://www.nlm.nih.gov/medlineplus/ency/article/000357.htm

The eight original comments were for the most part skeptical of her science and her naturopathic guru. Me thinks the powers that be at the Ho-Po have shut down the blog...no additional comments for the past 17 hours and no comments "in moderation".

@ THS:

I thank you for your kind words: where do I send the money?

At any rate, jealousy and anger seethe at websites like AoA. TMR, Natural News, PRN.. they forever cast apersion upon anyone who critiques their so-called pearls of wisdom and dearly beloved theoretical stylings. Null speaks about the "cult of the expert" and how society "worships" the professional ( instead of him, I suppose) which illustrates irrevocable corruption and inability to discern greatness.

These fellows have increbible ambition unsupported by long years of education, training and hard work: they expected to lead movements and become famous for their brilliance: which -btw- never happened. Even now, both of them dream about leading revolutionary paradigm shifts in science and society. Angry rants by Adams similarly instruct us that h3ll hath no fury like a woo-man scorned.

By Denice Walter (not verified) on 09 Nov 2012 #permalink

INCREDIBLE ambition.

By Denice Walter (not verified) on 09 Nov 2012 #permalink

Yeesh. All I did is point out some problems with a restricted diet.

http://www.amazon.com/Dietary-Interventions-Autism-Spectrum-Disorders/d…

This book is a good read. At the end of the book is a table listing various restricted diets AND the likely nutrient deficiencies of such diets.

What I don't understand is why anyone considers themselves a "vegan" if they are only theoretically a vegan but in practice an omnivore.

One of my comments got "through" moderation at the Ho-Po.

Anj, I think it was the late food writer Laurie Colwin who observed that for some people, chicken is a vegetable.

It *has to be hamburgers* tonight because Sandy and the nor'easter walloped our budget.

... and just picked the last remaining peppers and tomatoes from the garden. The beets, carrots and chard can stay in the ground.

Later this evening we will be going to the neighborhood French inspired small plates restaurant where veggies are lovingly prepared with lots of butter, cream and cheese. This is what I get after creating a couple of lovely veggie full dinners. Last night I made chicken pot turnovers for four with just one chicken breast, lots of veg and very little sauce. The flatbread had arugula on top the day before.

Unlike my hubby's Dutch grandparents were everything is braised in a bath of butter (even steak!), I need to start with variations of mirepoix. I can use less hamburger in Sloppy Joes by adding carrots (and sometimes celery), and grated carrots help make a tasty beef bourguignon (as does using the leanest inexpensive meat that needs five hours in a low oven).

@ Chris: It's a little early for the foodies to come out and play :-)

Along with the burgers I'm *doing* sauteed cauliflower florets, garlic and a dash of dried peperoncini.

Later this evening we will be going to the neighborhood French inspired small plates restaurant where veggies are lovingly prepared with lots of butter, cream and cheese.

Demand a deep-fried egg to test their mettle.

Oh, well. Actually one salad comes with a nicely coddled egg.

No, thank you. That is not French inspired. More than likely there will be miniature tarte tatin or pumpkin creme brulee.

That is not French inspired.

How about a perfect, miniature croquembouche?

Now that would be lovely. Tiny little crispy kisses of pastry and cream and sugar threads.

Good move going to NatGeo. Didn't you used to get comments? Hardly seems worthwhile to keep this thing going. But then what else could you do? : (

Well, at least there's still Narad.

By Sid Offit (not verified) on 09 Nov 2012 #permalink

Hardly seems worthwhile to keep this thing going.

I hear that's what your Old Lady says, too, Bob.

As a former member of the Worried Well, I can confirm what our esteemed Ms. Walter said above is true. I'll also tell you that gnawing, existential fear drives most people to alt med. Back when I was working for Whole Life Expo's new age dog and pony show, everyone I worked with seemed scared to death of, well . . . death.

Food was especially suspect in this crowd, with bizarre and esoteric diets being highly favored as "healing. As for me, though ripped and slender at the time (1999), I eagerly embraced the "Neanderthin" diet with a zeal that would put most Taliban to shame. I also spend a year living the Lights Out lifestyle. According to the author of that august tome, it was electric lights after sundown that was killing us. I totally bought it. And homeopathy. And adrenal supplements. And orgone blankets. And ozone machines. And, well, we could be here all night.

The thing is, I'm a smart guy, and I was then, but fear, oh man, fear is a monster. It took ten years and two deaths to snap me out of my angst. I gave a talk on this and how it affected my life (and ended a good friend's) at SkeptiCal this spring, and I got a lot of people coming up after the talk and thanking me for making them feel a little less crazy for the things they used to believe. It's why L. Ron Hubbard admonished his minions to "find people's ruin." Once you know what scares 'em, they can be yours for life.

By Pareidolius (not verified) on 09 Nov 2012 #permalink

Yes! As someone with Addison's Disease I'm forever biting my tongue and sighing internally when anyone brings up Adrenal Fatigue. Mercola and his kin have a lot to answer for.
With Megan's history and apparent restrictive eating I'd be far more likely to be looking at nutritional issues to solve her problems. Low blood pressure? Dehydration? Menstrual issues? If it looks like a horse then it's probably not a zebra.

Well, I just may have a condition caused “adrenal fatigue” brought on by the high levels of stress I have been under over the course of the past few years.

Now, this may just be coincidence but a lot of alt med diagnoses I've heard or read about seem to all involve a problem with "stress." It's always "high levels" and the patient has been under too much. They have been worrying too much. They have been doing too much. They have been unappreciated. They have been emotionally hurt. Things -- life, job, people -- have been unfair and too busy and not nice enough. The patient needs to take more time, receive more compliments, get more love. Stress is at the center of all illnesses. It's the root cause. It's the problem.

There may be some truth in this, but it occurs to me that the remedy to "stress" sounds rather pleasant. Perhaps this is yet another motivation?

Sid Offal dropped by and I was offline...too bad.

I guess he's in a snit because Obama won and Romney/Ryan lost. Gee Sid, maybe you'll be paying more income tax now for education, public roads and for funding public health clinics.

Although in the case, inadequate nutrition is the likely culprit (as Pip mentioned the menstrual irregularities are a red flag) , I suspect the cause of much "adrenal fatigue" is simply lack of sleep. Of course there is little money to be made from someone turning off the TV and getting off the internet at a reasonable hour.

By Militant Agnostic (not verified) on 09 Nov 2012 #permalink

Why are omnivores so hell bent on trying to paint people who don’t eat flesh foods (or animal products at all in the case of vegans) as wild-eyed lunatics? Is it so awful to care about animals enough to not eat them?

What to eat (within the limits of adequate nutrition–which does not require flesh) is a philosophical or moral question, not a scientific one and to equate veganism with medical woo is, well, unscientific.

I can't of course speak for all omnivores out there, JBC, but I think this is a misunderstanding.

It's not that omnivores want to paint all vegans as wild-eyed lunatics who have crazy ideas about what is and isn't good to eat ...

... it's that when you hold up someone who is clearly a wild-eyed lunatic with crazy ideas about what is and isn't good to eat, an awful lot of the time, those crazy ideas will fall into the category "vegan."

It's like the relationship between gun nuttery and America, perhaps. It's not the case that everyone in America is a gun nut; it's not even the case that all American gun owners are gun nuts. But if you picked a gun nut at random from out of all the gun nuts in the world, chances are he or she would probably be an American gun owner.

Sadly, most people aren't used to thinking about relationships like this with any precision, so they tend to wrongly conclude that "a lot of A are in category B; therefore the majority of B must be in category A." Short of sitting every person out there down and whacking them over the head until they learn to pass the Wason selection task, I'm not sure there's much that can be done about that.

But as Edith Prickly points out, Pearson is not just a vegan, she's a raw vegan. I'm not a doctor or a dietician or a nutritionist, but that being said, I'm unaware of any circumstances, even rare medical conditions, where "raw food only" is a sensible guiding principle for a diet. Cooking our food helps us get more nutrition out of it, not the other way around; if we hadn't learned to extract that extra nutrition by cooking, we might have evolved multi-chambered stomachs as the cows did, or worse, we'd have evolved to give our systems an extra chance to break down plants for their nutrition the way the rabbits do. (Don't google unless your stomach is strong, but if you do, then ask yourself, "would this behavior ever have evolved if raw plants were actually healthy for you than plants broken down for more complete digestion?")

By Antaeus Feldspar (not verified) on 10 Nov 2012 #permalink

So, I've got this low blood pressure (once, when I was an adolescent, a doctor measured it and asked jokingly "Are you still alive?"). I've also got very slow blood pulse, usually about 40 per minute and it doesn't get much faster even after exercise (I'd probably fall down exhausted before I reached the pulse levels recommended as best for exercise and to burn fat). When I was younger, I used to faint sometimes, now I try to get enough sleep and moderate exercise, which seems to help. I know I'm just like this, it's one of those precious few things I've inherited from my father (along with low platulet count). I don't go to doctors with it, I don't take any supplements and in general I'm not worried.

Although I must admit that it can be tiring and dispiriting if you've been going to a doctor and making various tests for the past six months and they still cannot find the reason for your really not very serious complaint (runny nose). But I'm resistant to woo, so I'm not going to visit a homeopath or naturopath - in worst case scenario, just buy a truckload of tissues.

@ Pareidolius:

I truly appreciate your kind words: there's really nothing I like more- although mirrors come close.

It's easy for smart people to get fooled by a line of bs that has been developed through trial and error by designing charlatans. Most of the exemplars in the field work over years or decades AND mimic their own teachers in the trade,; unfortunately, many have learned how best to bait their traps for the unsuspecting.

I know 2 business men who have entertained some woo-ish notions about diet and supplementation that veered away from SBM: often bright people focus on their own areas and don't also study science HOWEVER the basic science they DID study - prior to age 18- laid sufficient groundwork towards their ultimate dismissing of woo- plain old bio and chemistry - and not being innumerate- goes far in innoculating people against the worst of the woo.

Also if we can illustrate how alt med is a BUSINESS often makes it clear to the vulnerable that woo isn't science, it's advertising.

-btw- I hardly imagine that his Lordship would approve of your former dietary choices and *lights out* lifestyle.
Everyone knows that electric lights provide programming cues that keep our brains functioning along the prescribed pathways which our masters approve.
I'm so pleased that you learned the errors of your ways.

By Denice Walter (not verified) on 10 Nov 2012 #permalink

@ Sastra:

Although the woo-meisters blame many ills on stress, it seems to me that they also do a good job of PROVOKING unnecessary stress as part of their sales pitch-
a few common gems:
they tell followers that the diet they consume will eventually lead to cancer and CVD;
they frighten people about how the powers-that-be CONTROL everything, crushing the average person;
they talk up any possible disaster that may occur-
MIke Adams is keen upon revolution and/ or economic collapse.
Null likes to scare people about nuclear meltdowns, AGW and solar flares dis-abling the electric grid.
( -btw- I think they get their ideas from pop culture movies)

Various woo-meisters and anti-vaxxers rant and rave about our toxic world- contaminated food, water, air and vaccines. Pharmaceuticals are the devil's own; you can't trust ANY experts: SBM, corporations, the government and the media are all in cahoots. Of course, the Tri-lats, Bilderburgs, NWO, Masons et al stand behind everything- pulling the strings.

They ramp up fear and capitalise on consumers' desperation. Scare 'em then sell 'em.

MY response to them: if I can't trust governments, universities, professionals or the media, why should I trust a barely educated charlatan who has a bill of goods and products to sell me?

By Denice Walter (not verified) on 10 Nov 2012 #permalink

@Denice Walker

"plain old bio and chemistry – and not being innumerate- goes far in innoculating people against the worst of the woo."

If it only worked in all cases... My mother-in-law holds a master's degree in pharmacy, used to work in a pharma company (and then for a pharma wholesaler). And she's so much into woo and quackery. If it was only her, I wouldn't mind, but she tries to force it on us (my husband is suffering from a chronic disease, well managed by mainstream pharmaceuticals, thank you). Homeopathy, multivitamin supplements, fish oils, energy healing, ginseng, you name it. And we have to be constantly alert, to stave off yet another of her bright ideas.
But on the other hand, when we once talked to her about psychotherapy, she went all "this is bullsh**, you just shove money up the therapist's a**" (in exactly those words). Well, I do believe that modern psychology has a much sounder science foundation than all of her various wonderful remedies.

@ Alia:

Sure. I think that general science is the start.
People who have studied medicine or other life sciences and have fallen by the wayside are perhaps another story.

I think that Quackwatch has an article about why professionals- especially those in auxilliary roles- might fall into the bucket of woo. They might think that their own work doesn't accomplish miracles most of the time, feel burnt out, want more recognition, disappointment...

Even those with a medical degree can respond to woo's siren song. Think about the famous ones; what lured a young GI researcher away from SBM, leading him to "chisel" data? Or a doctor, like Mercola, who could earn a decent living and really help people as a SB DO? Fame? Money? Compensation for personal failings?

About psychotherapy/ counselling:
even in my own area, there's *beaucoup de* woo but there are areas that pass the SB test and are useful in helping people find ways to improve their day-to-day lives in practical ways. I think of it as being education for skills.

By Denice Walter (not verified) on 10 Nov 2012 #permalink

@ Denice Walter

My mother-in-law was suffering from depression. She was on medication but we thought that therapy could augument that. The thing is, she is a person who has a tendency to make life difficult for herself and everyone around. And it could be helpful if she recognized some of mechanisms that govern her behaviour.
But no, therapy is rubbish, she would rather go for experimental brain surgery or hypnosis.

Is she by any chance trying St John's Wort, 5-htp or niacin?
Or (( shudder)) EFT?
Make that Double (( SHUDDER)).

By Denice Walter (not verified) on 10 Nov 2012 #permalink

Fortunately not. She used to take St John's Wort pills, but quickly moved on to citalopramum and alprazolamum. And of course fish oils, because they do wonders for one's mental health, as she claims - but these are pretty harmless, I guess.

This seems to be turning into a woo believers anonymous meeting but.....
@Ms T
@Pareidolius
You guys have got nothing on me! Ive been taken in by: Reiki, Homeopathy, acupuncture,vitalism of all sorts, chiropractic of different falvours, herbalism, astral projection ('It didnt work for me but Im sure Im doing it wrong...'),positive thinking, NLP and magical eastern martial arts.
How did I believe it? It started with the martial arts and relied on three of my many weaknesses- Deference to authority, naivete ('why would they lie about something so important?!') and wanting to appear tolerant and open minded in the warped definition of the term woosters use.
Also I had many different symptoms that there wasnt an obvious diagnosis for and unfortunately (or fortunately) I had lots of instances of those symptoms disappearing soon after woo treatments.
Luckily every time I read a good scientific rebuttal of something I took it seriously and began to see the cracks in the image of my 'teachers' and the deeper I looked the more I found. Strangely it was Derren Browns books that made me really start thinking critically. I thought how can people see this guy and not want to be able to do that?
But despite having been part of the woo fan club for 9 years and the woo tolerators club for a further 3 I never knew about the skeptical community. It was only a few months ago, after 2 years of thinking I was the weird one, in a conversation someone told me 'Hey, check out this site, its full of people like you'.
Remember when Cern was possibly sending Neutrinos faster than light? And people said (rightly) if this is true then lots of what we think to be true is in fact wrong? Scientists seemed excited about that. My friends in the alt-med community get very defensive because its taken them years to build up what in their minds is a working model of what reality is. If their core ideas are wrong it puts them back 20 years, takes their livelihood, means they should shell out on a real education and start at the bottom of a new ladder. This is scary enough for them to really make themselves believe, like a sort of ideological Stockholm syndrome.
Thats my tentative hypothesis anyway. I have no way of testing it.

By Woefully Under… (not verified) on 11 Nov 2012 #permalink

@ Woefully Undereducated:

Welcome aboard!
I think that you do indeed have insight into alt med advocates' investment in their belief system. Woo serves many purposes for some of them: it provides a livlihood, a community, a sense of superiority as well as other ego boosts.

I often observe followers posture in imitation of their leaders, echoing their sentiments and styling themselves after them in other ways. Occasionally one of them 'sets up' on his or her own: a student/ patient of a woo-meister becomes a practitioner, a reader of a woo-blog starts submitting posts, autism parents inspired by the 'wisdom' of AoA stalwarts set up their own franchise.

Above, I try to illustrate my own slant on alt media and why certain people become enamoured and wedded to woo.

By Denice Walter (not verified) on 11 Nov 2012 #permalink

I guess in many cases people fall for woo because it's the easy way out. Why exercise and limit your daily food intake, when you can take this or that magical supplement that will melt your fat? Why change your lifestyle, get more sleep, eat less fast food and more fruit and vegetables, while you can take daily multivitamin? At least that seems to be the reason my mother-in-law falls for all this stuff.

@ Denice Walter
Thanks! Im normally happy to read the arguments or ideas of those on here with very strong subject knowledge unless I have a question but its nice to think my experiences might help someone conceive a way to reach some of those on the fence. The ones without a dog in the fight who just want to improve their health.
I think the question of how people believe woo in the first place is often easily answered - For me and those I know who are still caught up in it, there was no strong science role models, no separation in the media between SBM and Alt med. There was simply no reason not to believe it.And once you are believing in one impossible idea, others suddenly seem more possible. I believed in vital energy. Why not vital energy transmitted through homeopathic remedies?
I studied science in school (Did really well in Biology) but there were huge gaps that woo could slip into with my lack of knowledge of how science actually works. Add to that, it often matches up with how we wish the world could work...
If science in schools focused a little more on what constitutes a good or bad study, What meta analysis is and why its important. I think we would see a dent in Woo profits.
Also I think many people who arent so vocal just think 'yeah, maybe its true, maybe its not. Whos to say?' And then lean to one side or the other are the majority who have the power to really starve the pseudo-scientists of indulgence.
Believe it or not Ive seen people of this type (who would never visit a site like this or one of the opposition) change their minds while watching Southpark! Many people just havent been presented with the right arguments in the right way.
Its the self delusion of remaining open minded that actually closed my mind to picking a side for quite a while.

By Woefully Under… (not verified) on 11 Nov 2012 #permalink

@ Woefully Undereducated:

Here are a few observations and questions that might assist anyone trying to influence the woo-entranced; you can adapt them to other situations:

If you've looked at Natural News or the Progressive Radio Network over the past few days, you would notice that the head honchos are not happy at all about the results of the ( US) election: each has launched into a series of screeds ( written and spoken) about the looming economic catastrophe certain to follow the re-election of the Great Dark Lord of Liberalism.

Question:
how can two barely educated *nutritionists* claim special insight into the mechanations of WORLD economics?

Yet over the past several years, both have expanded their venues to include both politics and economics. First, they became experts in health who understood illness better than doctors, then they expanded to include psychology, questioning research and practitioners in this field as well.

Question:
How can people with an average education ( I'm being kind) INSTRUCT the general public about SEVERAL areas of expertise that probably each require graduate level studies to comprehend fully. Possibly the general audience may be more informed and brighter than their so-called teachers.

Woo-meisters and anti-vaxxers ask us to believe that whatever we've studied at universities, learned from medical professionals and the government or heard from the media is ALL wrong.

Question:
If I shouldn't believe what any of these institutions tell me, why should believe a guy on the internet?

Similarly, we're told that Wakefield was correct but a massive conspiracy of the elite ( government, professional associations, media) set out to destroy his credibility.

Question:
How could such a massive conspiracy be maintained? Is it more likely that there are THOUSANDS of frauds or a single, solitary fraudster and "chiseler" of data?

Usually woo-meisters must resort ot conspiracy to explain why their unfettered BRILLIANCE isn't recognised and accepted by the establishment.
I can think of other reasons why it isn't.

By Denice Walter (not verified) on 11 Nov 2012 #permalink

Oh no, I have adrenal fatigue!! Eleventy!

Actually, what I do have, is Crohn's Disease and Fibromyalgia. Both were diagnosed by real doctors and are being treated with a range of medications and allied therapies (physiotherapy, massage, dietitians, exercise). I realise fibromyalgia is treated by many as a made up disease - until someone can come up with another name for the fatigue and pain that I'm constantly suffering, I'll keep it.

I would join the rest of the commenters here who think Pearson's problems are caused by nutritional deficiencies.

By Christine (the… (not verified) on 11 Nov 2012 #permalink

Orac, Orac, I would love to see you take on "adrenal fatigue." I just found out a relative thinks he has it. See, I sent him some info about POTS, which seems to run in families, and I've just learned is itself an adrenal disorder (poor autonomic handling). He came back with, "Oh, but I don't have ENOUGH adrenaline, because of loss of adrenaline during adrenaline surges due to stress. And I have too much to do to rest like I'm supposed to to build up my body's ability to produce more." Uh oh.

FWIW, sometimes people with a pile of apparently-inconsequential complaints--that, all together, are life affecting--really do go to doctors and say, "Look, all this crap is wrong with me! I don't know why! Help! You tell me what to do, I just want help!" and get blown off and rushed out the door. Not stand there telling the docs what to do, not stand there being pouty or uncooperative, just asking for any kind of help they can give. I had one who clearly thought I was a hypochondriac. Yeah, eventually we get sick of doctors. (But sometimes we luck out and find a specialist who can explain that the thing we were diagnosed with years ago, the one the diagnostic doctors told us was not really a problem, can cause every. single. one. of those apparently-inconsequential issues, along with a couple of others that are pretty consequential. And there's //real medications// that can help, and also kind of obscure lifestyle changes that should be adopted Always nice when that happens. Much better than a doc who mutters something about adrenal fatigue and "nutraceuticals" or chronic fatigue or chronic Lyme or just plain thinks you're a hypochondriac. I'm rambling a bit. I'm happy, My apologies.)

~ ~ ~

Please. An RI handling of "adrenal fatigue" would be lovely to behold.

For a moment, I thought you'd be delving into this one: http://www.huffingtonpost.com/david-wallinga-md/food-toxics-adhd_b_1994… in which I discovered, surprise surprise, that there's a brand new "science" out there called "macroepigenetics." Contrary to what you might think, it is not macro, nor does it actually relate to epigenetics, but it is specifically the study of how high fructose corn syrup causes autism and ADHD. The methodology involves finding numbers you like from obscure studies, mushing them up a bit, and then publishing in a journal of questionable worth.

So it's never about finding the actual answers to questions, but finding the questions to the answers you already made up. Oh, huffpo. . .

Hi Orac,

This post is really interesting to me for a number of reasons. Firstly, I used to be a patient of Dr. Erin Wiley. I used to comment on your blog a fair amount before I began my undergraduate degree and ran out of spare time. I may have emailed you a time or two as well.

I had been having on again off again skin conditions that had been diagnosed as eczema, dermatitis and psoriasis depending on how it looked and which professional was looking at me at the time. Fed up with tar shampoos and steroid creams, I decided to enlist the help of a naturopath to help work on my diet (I'm vegetarian) and for easier access to some fatty acid tests and food allergy tests unavailable at my MD. I should mention that the visits, but not prescriptions, were covered by my health plan so I figured I might as well investigate.

All of this was happening to me at a time when my health issues had driven me far into the woo territory due to lack of answers from SBM so I have experienced this effect first hand. Luckily, my private research drove me to find your blog as well so I had a counter-measure to all the alt-med feel-goodery I was encountering. So I went through the fatty acid tests and allergy tests and they were inconclusive as well.

I was in the middle of a painful outbreak of "whatever" on my face an during a visit to Dr Wiley to follow up on my test results and come up with a plan, she offered me the "power" of homeopathic medicine. Alarm bells ringing! Without hesitation I stated quite clearly, "You are trying to give me a placebo. How are you going to know if my skin, which we know goes through remission already, has been helped by these pills?" She simply smiled and said, "Have you ever heard of the Law of Similars?" I hadn't been exposed to any woo in her office before this point so I was stunned by it and let her give her explanation and took the pills but never imbibed. On exit she tried to sell me more and I refused. I went to a local health food store and found out her placebos were 3x as expensive as the store bought placebos. Distraught by this, I never returned.

So, I just wanted you to know that you have definitely had an effect on my life, at the very least, so thanks for that. Please continue what you do with my support.

@lilady - I'm glad there are others with the gumption to take it on there. I just can't wade through it, and would rather come straight here for the take-down!

But it looks like your comments were approved!

@Krebiozen Adrenal fatigue is a misnomer term for a hypothalamic/pituitary axis disorder. So yes, she probably has issues in hormonal signaling. There are better ways of diagnosing it than the gravity test and hopefully she has had a cortisol rhythm test.

Right now, there is a large push in naturopathy for standardization and codification of treatment. But if your attack on naturopathy is that there are crazy naturopaths, I can offer you many a crazy MD (most notably Dr. Jack Kruse and Dr. Klinghardt).

Andrew - If I read Orac's criticisms correctly, his issue with naturopathy is not that there are a a few crazies, but that the basis of naturopathy - as defined by the curriculum, the statements of its professional bodies, and of course the public pronouncements of its practitioners - includes things that are not backed up by science.

By Mephistopheles… (not verified) on 25 Nov 2012 #permalink

Adrenal fatigue is a misnomer term for a hypothalamic/pituitary axis disorder.

I would note that this sentence works just as well with the deck chairs reversed.

Andrew,

Adrenal fatigue is a misnomer term for a hypothalamic/pituitary axis disorder.

No, it's a bogus diagnosis used in people who have normal adrenal function and whose symptoms are caused by something else. Hypothalamic and pituitary disorders are very rare, while 'adrenal fatigue' is the quack diagnosis du jour.

By Krebiozen (not verified) on 25 Nov 2012 #permalink

this sentence works just as well with the deck chairs reversed

Ah, the Postmodernism Test.
The Derrida who can be understood is not the true Derrida.

By herr doktor bimler (not verified) on 26 Nov 2012 #permalink