You can’t have naturopathy without homeopathy

Sometimes a comment in the comment thread after one of my posts ends up turning into the inspiration for another post. This is especially likely to happen if I respond to that comment and end up writing a comment of myself that seems way too good to waste, forever buried in the comments where, as soon as the commenting on the post dies down, it remains, unread again. So it was after my post on the “integration” of quackery into academic medical centers. In that post, I applied some of my inimitable not-so-Respectful Insolence to a deal between Georgetown University, what should be a bastion of academia emphasizing science-based medicine, and Bastyr University, probably the most famous school of naturopathy in the United States. A commenter objected to my lumping naturopathy in with quackery like homeopathy and reiki.

Quoth Kelly:

Bastyr has a good reputation. Do they embrace woo there? Sure, but they also don’t force it on anyone, and they embrace the scientific method in their research and teaching.

Lumping in naturopathy along with homeopathy, reiki, and so forth, just makes you look ignorant in the end. And that’s a shame, especially since so much of medicine is moving forward to acknowledge that reductionism in medicine (and pharma, thanksomuch) is a bad thing.

Leaving aside that this quote is self-contradictory (the part about admitting that Bastyr embraces woo but embraces the scientific method in research and teaching), it’s also plain wrong. It demonstrates a fundamental ignorance of what naturopathy is. In fact, there is no woo that I’ve yet been able to find that naturopathy doesn’t embrace. As an example, I thought I’d take a look at homeopathy and how naturopathy not only embraces it, but requires it. Let’s start by looking at Bastyr University itself. Here is what the Bastyr University website says about homeopathy. First, it describes homeopathy as “natural” and “nontoxic” (the latter of which is hard to argue with, given that it’s nothing more than water). Moreover, Bastyr even offers homeopathy services in its clinics.

More pertinent to the question of whether naturopathy embraces homeopathy is this answer to a question in Bastyr’s FAQ about homeopathy:

Q. Do all naturopathic physicians use homeopathy?

A. All naturopathic physicians are trained in the use of homeopathy, but not every naturopathic physician will use it as part of their treatment.

Let’s repeat that: All naturopathic physicians are trained in the use of homeopathy. All of them.

Of course, there’s a lot of homeopathy going on at Bastyr University. For example, if you look at its curriculum to become a doctor of naturopathic medicine, you’ll rapidly see that Bastyr requires a full year of homeopathy courses spread out over three classes for a total of 8 credit hours. The same is true for Bastyr’s five year track and its combined degree of Doctor of Naturopathic Medicine (ND)/Master of Science in Acupuncture (MSA) or Acupuncture and Oriental Medicine (MSAOM). In addition, Bastyr has a clinical homeopathy department and homeopathy teaching clinic. The department chair is a naturopath and homeopath named Richard Mann, ND (the “ND” stands for “not a doctor,” as far as I’m concerned).

Then there’s the American Association of Naturopathic Physicians (AANP). If you take a look at its blog and search it for the word “homeopathy, you’ll rapidly see that the largest “professional” organization of naturopaths not only embraces homeopathy but defends it against attacks. Perhaps the best example of the attitude of of the AANP towards homeopathy is found in this post from several months ago entitled Getting over it. In it, a naturopath named Christopher Johnson gets all indignant about recent “1023” campaigns that skeptics and proponents of science-based medicine have been using with some success to demonstrate the utter ridiculousness of homeopathy. (Indeed, one such event is scheduled for February 6.) In response, Johnson writes:

They named their campaign “10:23”, a reference to Avogadro’s number. This number is significant to chemists in that it supposedly sets the limit below which no material elements are likely to be present in a given dilution. Homeopathic remedies are made with solutions far more dilute than Avogadro’s number.

Do these “skeptics” really think the public cares about Avogadro’s number when homeopathy has just significantly improved their toddler’s autism or offered help with any of a vast range of diseases which respond so well to homeopathic (and often not to conventional) treatment?

This is just another tantrum by the clueless wing of the scientific/medical community that can’t understand why the people don’t praise them for their ideological purity and courage, even when the fruits of their scientific labors rot like a brown banana. Note to protestors: maybe they’re just not that into you.

Remember, this is the official blog of the AANP, and it’s attacking a valid criticism of homeopathy, namely that many, if not most, homeopathic remedies are diluted far, far more than Avagadro’s number, meaning that it’s highly unlikely (damned near impossible, actually) that a single molecule of the original starting material for the homeopathic remedie remains. When a typical homeopathic dilution is 30C (thirty 100-fold dilutions, or a 1060 dilution), that’s almost 1037-fold higher than Avagadro’s number. The magnitude of this dilution is simply incredible, and the odds against a single molecule remaining are just as incredible.

Particularly amusingly, Johnson likens these 1023 events to the persecution of Galileo in what is arguably one of the most hilariously over-the-top invocations of the “Galileo gambit” I’ve ever seen before. Behold:

These hooligans purport to stand up for scientific principles, while in fact their zealous dogmatism and denial of evidence would make Galileo’s persecutors proud. Score one for book burning and witch trials.

Because making fun of pseudoscience like homeopathy in such a way as to point out to nonscientists why it is pseudoscientific nonsense is exactly like putting Galileo under house arrest and burning books and witches. I am thankful for small favors in that Johnson restrained himself from comparing skeptics to Hitler or Nazis. Just barely. (Come on, Mr. Johnson, let it out. Compare skeptics to Nazis! You know you really, really want to.)

Of course, so far, all I’ve looked at is Bastyr University and the official blog of the AANP. Maybe that’s not enough to convince you that homeopathy is part and parcel of naturopathy. In fact, though, every school of naturopathy whose curriculum I’ve looked at includes a heapin’ helpin’ of homeopathy. It’s no wonder, too. the NPLEX (Naturopathic Physicians Licensing Examinations), which is required for naturopaths to be licensed in the 16 states in the U.S. and 5 provinces in Canada that license naturopathic physicians tests naturopaths on homeopathy:

The current examination, based on these original blueprints, forms the Core Clinical Science Examination now required by every state and province that regulates the practice of naturopathic medicine. The Core Clinical Science Examination is a case-based examination that covers the following topics: diagnosis physical, clinical, lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, counseling, behavioral medicine, health psychology, emergency medicine, medical procedures, public health, pharmacology, and research. Two additional treatment examinations (Minor Surgery and Acupuncture) may also be required for eligibility to become licensed to practice as a naturopathic physician in some jurisdictions.

[…]

The NPLEX Part II – Core Clinical Science Examination is designed to test your knowledge of: diagnosis (physical, clinical, and lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, counseling, behavioral medicine, health psychology, medical procedures, emergency medicine, public health, pharmacology, and research. The examination is comprised of a series of clinical summaries followed by several questions pertaining to each patient’s case. For example, you might be asked to provide a differential diagnosis, to select appropriate lab tests, to prescribe therapies which safely address the patient’s condition, and to respond to acute care emergencies.

I don’t know whether to laugh or cry to read about the NPLEX. Think about it this way. There is actually a North American Board of Naturopathic Examiners, just like medicine’s National Board of Medical Examiners. the NABNE even has a certifying examination, just like real doctors! It’s all science-y and medicine-y, with all the trappings of science-based medicine but none of the rigor, despite the seeming appearance of having them. Worse, there are far too many states and far too many provinces that actually legitimize naturopathy by licensing it.

Naturopaths like to present naturopathy as the “respectable” face of “complementary and alternative medicine” (CAM). To that end, institutions like Bastyr have tried their best to forge relationships with reputable universities like Georgetown or the University of Washington, among many others. Indeed, Bastyr has forged a collaboration with the Fred Hutchinson Cancer Center at the University of Washington in order to study woo:

Founded with the help of a generous donation by Cleavage Creek Cellars, BIORC is collaborating with the Fred Hutchinson Cancer Research Center in Seattle on a matched controlled-outcomes study. This study will compare the ‘disease free survival’ and quality of life of participants treated at BIORC to the experience of similar cancer patients living in Washington state who do not include complementary, alternative or integrative therapies in their treatment. We anticipate that men, women, and children with cancer who are treated at the Bastyr Integrative Oncology Research Center will live longer and healthier lives.

In 2010 Bastyr, along with the Hutchinson Center, received a $3.1 million grant for the study of complementary and integrative care for breast cancer. The grant, awarded by the National Institutes of Health (NIH), National Center for Complementary and Alternative Medicine (NCCAM), funds a project entitled “Breast Cancer Integrative Oncology: Prospective Matched Controlled Outcomes Study.” The five-year award will allow clinical investigators at the Bastyr University Research Institute and the Hutchinson Center to undertake a rigorous outcomes-based research study. Investigators will track clinical outcomes for participants with breast cancer who, in addition to standard conventional care, receive integrative care at BIORC. Those outcomes will then be compared with outcomes for participants with breast cancer who do not receive integrative care along with conventional care.

Are either of these trials randomized? Nope, it doesn’t look like it. It’s a prospective trial, but the patients decide which group they’re in. Granted, sometiems such studies are all that is possible when studying interventions that can’t easily be randomized, but in this case I see the potential for confounding factors to be so strong as to make a study like this pretty much pointless. How much do you want to bet that the patients who receive “integrative care” with their conventional care will be found to do better by some measure, probably in quality of life measures. Whether or not there is a difference in disease-free survival, I don’t know. However, what I don’t doubt is that there will be significant differences between the two groups in composition. Most likely, the “integrative” group will live in different places, have more money, and have more time to indulge themselves in “integrative” therapies. Comparison will be particularly difficult given that the study will be comparing patients who have received a wide variety of CAM modalities in addition to their conventional cancer therapy.

The bottom line is that, for how badly its practitioners want to represent naturopathy as science-based and rational, in reality naturopathy is anything but. It embraces virtually any form of CAM therapy, no matter how irrational, and its practitioners simply choose what subset of woo they want to use in their practice. If you want to know just how credulous and pseudoscientific naturopathy is, just remember that not only is homeopathy embraced by naturopaths, but knowledge of homeopathic practice is mandatory. It’s taught by naturopathy schools, and naturopaths have to know enough about it to pass the NPLEX, which includes homeopathy on it.

Homeopathy and naturopathy: Two crappy woos that taste crappy together.