The problem with homeopathy, according to naturopaths

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.