Fun with a naturopathic rant against The SkepDoc

As many of you probably know, I’m proud to call Dr. Harriet Hall (a.k.a. the SkepDoc) my friend, and, I daresay, so is my wife. We’ve both hung out with her at the last two TAMs, and we’ve hit it off pretty well. I also admire her history of standing up for science, reason, and science-based medicine, something she’s been doing longer than I have. I can only hope that one day I will reach her level of respect within the skeptical movement. Unfortunately, that will probably never happen until I cease being a Plexiglass box of multicolored blinking lights, but such is the price of pseudonymity. My skeptic envy aside, that’s why when a naturopath woo-meister decides to take a swipe at Harriet, I can’t let that stand. True, I know that she’s perfectly capable of taking care of herself in these exchanges, but I also know she’s too classy to get down and dirty in the mud.

Fortunately, as you all know, I have no such qualms. Well, most of the time, at least. So, Oryoki Bowl, prepare for a much deserved dose of not-so-Respectful Insolence for your post The SkepDoc is an Ostrich:

I chose the word Ostrich, because I see your head is buried in the sand and your ass is likely waving in the air.

I suppose this is what passes for cleverness in Oryoki’s fragile eggshell mind, but let’s see what the meat of her complaint is, that is, if there is any meat:

Unfortunately, reading through your 6 column, 2 page diatribe against naturopathic medicine, your talking points were off target. I am sorry you don’t understand what naturopathy is. You said so in your first paragraph, yet still felt entitled to dissect and discredit something you just admitted you didn’t understand. You did some random research. You made a lot of gross generalizations and tried a lot of scare tactics. You made up long stories to discredit people using the same rationales you were dismissing.

It’s not exactly true that Harriet said that she doesn’t understand what naturopathy is. Yes, she did say that, but she qualified it thusly:

When people ask me, “What is naturopathy?” I have never been able to give a good, concise answer. I can confidently explain what acupuncture, chiropractic, and homeopathy are all about, but naturopathy has eluded me. I finally realized that it’s not my fault. The whole concept is so ill-conceived and poorly defined that it cannot be grasped with a single definition. It is so nebulous that it allows its practitioners to believe and do almost anything. It is loosely unified by an emphasis on natural treatments that allow the body to heal itself, and an avoidance of drugs and surgery.

The best response that Oryoki can come up with this is to that’s a “mighty fine skeptic argument there” and that it “sounds like voodoo,” the latter of which is a perfect example of a tu quoque logical fallacy.

It’s true, too. I’ve studied about as much about naturopathy as is possible without actually going to naturopathy school. I’ve studied under the tutelage of Kimball Atwood, who has studied and written even more than I have over an even longer period of time. In fact, if Oryoki really wants to burst a cerebral aneurysm, I suggest that she read Dr. Atwood’s Why Naturopaths should not be licensed, his testimony against licensing naturopaths in Massachussetts, and Naturopathy, Pseudoscience, and Medicine: Myths and Fallacies vs Truth. Let’s just put it this way, any “discipline” that accepts that homeopathy is true and a valid therapeutic modality can’t be considered scientific by any stretch of the imagination. Indeed, as I’ve described before, you can’t have naturopathy without homeopathy. It’s part and parcel of naturopathy.

Of course, to Oryoki, it’s not about science. Oh, she does claim she’s all about the science, but nowhere in her rant can she actually counter the science Harriet discusses. All she can do is to engage in a bunch of conspiracy-mongering. She paints naturopaths as “persecuted” by the AMA:

For the record, the reason naturopathic medicine is not universally recognized is because of money. The AMA has at its core a mission to wipe homeopathy and naturopathy off the professional field. They spend their lobby dollars fighting our lobby dollars. Our lobby dollars fight for licensing and higher medical standards. We are challenged by MDs, who also challenged the DOs until they co-opted them. We are challenged by chiropractors who were challenged by MDs. We are challenged by people who go to school in unlicensed- and therefore unregulated states- who want the title but not the education. You suggest we are encouraged to sell supplements at our clinics. MDs make money selling supplements as well, also getting lots of free lunches, supplies and fabulous resort dinners from their suppliers. Except the MD world is owned by big pharmacy and big insurance, and we are not. Look at Cancer Treatment Centers of America, they are some of our proudest supporters. We are part of the whole team. Last year, I was hired by a hospice to help develop a program for their patients seeking touch therapy and acupuncture for pain and anxiety. Sadly, since Medicare wouldn’t pay for it and our state budget axed, it could not be implemented. I guess alternative care is only good for rich or stupid people.

Well, not exactly. As I’ve said time and time again, you don’t have to be stupid to be taken in by “alternative” practitioners, be they naturopaths, homeopaths, or practitioners of traditional Chinese medicine. What is necessary is a lack of understanding of science and, most importantly, Richard Feynman’s old adage, “The first principle is that you must not fool yourself–and you are the easiest person to fool.” It has nothing to do with intelligence, either; some highly intelligent people don’t realize when they are being fooled, perhaps even Oryoki. In fact, often intelligent people are the easiest to fool, mainly because their intelligence leads them to falsely believe that their knowledge and expertise in one area inoculates them from making fools of themselves in other areas. Sadly, it’s not so.

Also, unfortunately, it’s not just lay people who forget how easy it is to be fooled; lots of physicians forget too. Naturopathy is built on the very premise of how easy it is to fool both practitioner and patient. It’s built up a very science-y sounding bunch of precepts. Schools of naturopathy, like Bastyr University have all the trappings of science, but at their core all the trappings of science lack the one key ingredient of science: Falsifiability and the abandonment of hypotheses not supported by science. If naturopathy did accept science, it would have to reject homeopathy and purge it from its armamentarium of accepted modalities. Indeed, you can see this inability to understand the true core of science in Oryoki’s post. At one point, she writes:

Am I working on a belief system? You betcha! I use science, which is empirical. I use traditional labs. I use alternative labs, when traditional labs are insufficient. Are they illegal or alien? No, just not common. I use chinese medicine. It is more useful for many of my chronic allergy patients who don’t respond to all the OTC and prescription meds.

Except how do you know if traditional Chinese medicine is “more useful” for your chronic allergy patients? Without actual science and clinical trials, you don’t. All you have is confirmation bias, placebo effects, and confusing correlation with causation. But you don’t believe that Oryoki is deluding herself when she declares herself to be all about the science, read this passage:

If you don’t believe in Qi, or the life force, you probably should be teaching anatomy and not going into patient care. If you can’t tell the difference, you don’t look closely enough at your patients. If you can’t tell from the way they walk into your room, from the color of their skin and eyes, the droop of their cheek, the shuffle of their legs, the sound of their voice, and get a really good sense of their vitality, you aren’t in the health business. Just sickness management.

Science. You keep using that word. I do not think it means what you think it means.

Let’s just put it this way. How a patient looks has nothing to do with qi, that mystical magical life force that woo-meisters claim to be the source of all healing but can seemingly never actually characterize or measure. Observing how patients walk, their color, their voice, their vitality does not require a belief in some woo-ful life force. It’s a matter of experience and pattern recognition. There’s something known in the biz as “looking sick.” Good physicians can observe a patient and immediately make an accurate snap judgment about how sick that patient is. It’s not magic. It doesn’t depend upon qi. It’s just a matter of having seen enough really sick patients to know the difference. We know when to be worried that a patient is about to crash and when not to worry. It’s a skill that in general physicians get better at the longer they practice, as long as they have the opportunity to care for really sick patients.

If you really want to know you’re dealing with a pseudoscience maven, though, there’s one pretty reliable measure, and Oryoki uses it in the comments:

I did not attack the medical community, I particularly refuted the vague generalizations made from narrow minded individuals this person made using her MD to give her credibility where there was none. I do the same with you. Placebo controlled trials are not the only standard of testing. Scientific method does not require placebo. You confused the two. There are a lot of studies on alternative medicine done to the highest standards available, they are findable, you can do the research (but you haven’t). They also cost millions to billions of dollars. Because you cannot patent naturally occurring substances, there is no money to pay back doing the research. The FDA does not control things that are not patented. Homeopathy, is, in fact, controlled by the FDA. It’s part of the original charter. Many of the studies done are done poorly, which is frustrating for everyone, as we have learned, scientism can make presumptions that are incorrect.

Yep, Orac’s law number five (or is it six?) states that a charge of “scientism” leveled against critics of woo is highly correlated with dedication to pure pseudoscience. So is the dubious claim that no one will do studies on natural products that can’t be patented, except that uses of natural products can indeed be patented. More importantly, Oryoki is full of, well, BS when she says that the FDA can’t regulate things that are not patented. That’s simply untrue. The FDA has regulatory control over generic medications, and generic medications don’t become generic medications until their patents expire. Similarly, the FDA does have regulatory control over unpatented supplements, thanks to the Dietary Supplements Health and Education Act of 1994. True, the DSHEA irresponsibly gutted much of the FDA’s control over supplements, but it still has some.

Oryoki appears to have taken Harriet’s criticisms of naturopathy very personally, resulting in an off-base attack on Harriet herself that relies on a heapin’ helpin’ of nonsense, pseudoscience, and logical fallacies, not to mention the misrepresentation of Harriet’s own words as saying that she doesn’t understand naturopathy. The fact is that Harriet actually understands naturopathy all too well, as does Kimball Atwood, and as do I.

And Oryoki knows it.