The insinuation of naturopathic quackery into law

If there’s one thing that practitioners of pseudoscientific medicine crave more than anything else, it’s respectability. Believing that science-based medicine is corrupt and that their woo is as good or better, they delude themselves into thinking that they can function as well or better than primary care doctors practice and therefore should be given the same privileges that physicians are granted. To them, it makes sense. On any objective basis, however, it does not. The reason is simple. The two most common “disciplines” that seek the same scope of practice as primary care doctors are chiropractors and naturopaths. By any objective or reasonable criteria, it’s utterly ridiculous to imagine that chiropractors, whose specialty is realigning nonexistent subluxations, would have the slightest clue how to take comprehensive care of patients—or even how to do anything other than infuse their variety of physical therapy with delusions of grandeur in which they imagine themselves capable of treating asthma, heart disease, and other serious conditions. Naturopaths, on the other hand, although just as quacky as chiropractors (perhaps even more so) tend to be able to make a case that sounds more convincing, not because their case actually is more convincing but rather because they can sound more convincing. After all, they have a wider cornucopia of quackery that, when combined with the mundane modalities of diet and exercise magically rebranded as being somehow unique to naturopathy and “alternative,” makes them seem like more comprehensive practitioners compared to the popular picture of chiropractors in the public mind of back crackers.

Unfortunately, naturopaths have been making inroads as well. They’ve actually been persuading some state legislatures that they know enough to prescribe medications and/or that their services are sufficiently valuable that it should be mandated by law that health insurance companies pay for them. Frequently, the argument is that they are cheaper than conventional medicine. Of this, there is little doubt. However, cheaper is not necessarily better. If the goal is to reduce costs by having more people die because they don’t receive appropriate science-based care, I suppose that empowering naturopaths to be roughly on par with primary care doctors makes a sort of perverse sense. That is not the sort of sense we should be invoking, though.

A recent development that’s been resonating through the naturopath community is New Hampshire House Bill 351. This is a bill that was recently passed that requires all private health insurance companies to reimburse naturopaths for their services. Yes, you heard it correctly. If you live in New Hampshire, part of your health insurance premiums are going to pay for naturopathy, and the naturopaths couldn’t be more ecstatic, as this misguided article full of false “balance” describes:

The recent passage of New Hampshire House Bill 351, which requires all private health insurers to cover services provided by naturopathic doctors, could be a game changer for alternative medicine in the state, one that could alter attitudes toward human health and well being.

The state Senate narrowly approved HB 351 in a 13-11 vote in early May and Gov. John Lynch signed it into law on June 20.

For Dr. Robyn Conte, ND, director of Starry Brook Natural Medicine in Exeter, such providers face their fair share of challenges and misconceptions, despite being subject to much of the same training and academic rigor as traditional doctors.

“We’re quite often the physician of last resort,” said Conte, who opened Starry Brook in 2010. “A lot of times we’ll have patients who’ve seen every specialist up and down the Seacoast, but who still haven’t gotten to the root causes for whatever ails them.”

Unfortunately, contrary to what Conte claims, naturopathy is nothing more than a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. It’s a hodge-podge, a grab bag of all sorts of unscientific and pseudoscientific medical treatments, most of which fall squarely into the “alternative” camp in every definition, particularly the part of the definition of “alternative” about either not working or not having been demonstrated to work. Naturopathy includes modalities that range from the relatively mundane appropriated from science-based medicine and magically rebranded as “alternative,” such as diet and exercise, to pure quackery, such as homeopathy, to downright dangerous pseudoscience, such as germ theory denialism and antivaccinationism.

As a result, typical naturopaths are more than happy in essence to “pick one from column A and one from column B” when it comes to quackery, 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. Despite their affinity for non-science-based medical systems, naturopaths crave the imprimatur of science. As a result, they desperately try to represent what they do as being science-based, and they’ve even set up research institutes, much like the departments, divisions, and institutes devoted to “complementary and alternative medicine” (CAM) that have cropped up on the campuses of legitimate medical schools and academic medical centers like so many weeds poking through the cracks in the edifice of science-based medicine.

Naturopaths also really, really don’t like it when they encounter criticism that their “discipline” is not science-based. Such criticism often comes in response to the common naturopath trope to claim that they have training just as rigorous as that of physicians. This is, of course, utter nonsense, a load of what Douglas Adams would call fetid dingo’s kidneys. Naturopaths might have a four year training program, which is the same length of time that medical school lasts, but that does not mean that naturopath training is in any way equivalent to medical school training. Naturopaths make a great show of trying to portray themselves as being science-based, as having scientific training every bit as rigorous as the scientific training that medical students receive. This is utter nonsense. Sure, naturopaths might take classes with the same names as classes in medical school, such as physiology, anatomy, and the like, but that doesn’t mean they are receiving an equivalent education. As a physician myself, I really hate it when reporters credulously swallow and regurgitate naturopath propaganda about how rigorous their training is and then regurgitate it in puff pieces like this. It’s an insult to physicians everywhere.

Think I exaggerate? Did I mention that homeopathy is an integral part of naturopathic education? If I didn’t, I will now. About a year and a half ago, I wrote one of my characteristic Orac-ian screeds describing how you can’t have naturopathy without homeopathy, how homeopathy is a required part of the educational curriculum for naturopaths. It’s required, and the naturopath board exam tests newly minted naturopaths on homeopathy, among other woo. I realize that my regular readers don’t require an explanation as to why homeopathy is nothing but the purest quackery, but it’s possible that newbies might. Basically, homeopathy is one of the most outrageously quacky forms of quackery that there is. It essentially advocates diluting remedies to the point where not a single molecule of the original substance remains and invokes various pseudoscientific explanations about the “memory of water” to “explain” how such high dilutions can allegedly do anything whatsoever. In fact, the only real problem with homeopathy to some naturopaths is not that it’s a risible load of pseudoscience, but that it isn’t being “taught properly” to budding naturopathy students and that they are afraid of it. After all, you don’t want to screw with someone’s VITAL FORCE, do you?

Why certainly not. At least, I don’t.

Personally, if you want to see what sort of awesome treatments Conte is recommending, I think it behooves us to go back to the tape, so to speak, and see what she says later int he article:

“Our thoroughness and the time we spend with each patient is I believe what sets us apart,” Conte said. “We’ll have patients who come to us because they’re curious about ‘alternative medicine’ and who end up converting all of their medical care to our practice.”

As with any traditional physician, a diagnosis from Conte carries with it a prescriptive solution. But instead of pills and surgeries often deployed in traditional health care — and which can mask rather than cure the underlying ailment — Starry Brook’s products and services are dynamic: Everything from vitamins to essential oils to massage therapy, acupuncture and diet counseling.

Such remedies might indicate a practice still squarely in the medical minority, but Conte said that doesn’t mean they aren’t the right ones.

No, the quackery embraced by naturopathy means they aren’t the right ones.

In fact, I thought it might be interesting to find out what sort of therapies Conte thinks to be science-based. We already know that she offers acupuncture and “essential oils,” but in fact she offers so much more than that, as her practice’s website shows. Here’s her web page:

Dr. Conte currently practices as a primary care physician, prescribing medications, ordering labs and imaging, performing physical exams, as well as offering her patients acupuncture, counseling, clinical nutrition, botanical medicine and homeopathy.

And:

She believes that homeopathy and botanical medicine complement dietary revision, lifestyle changes, and mind-body therapies to help restore balance for her patients.

Her practice offers the same veritable cornucopia of woo that naturopathy is, including nutritional IV therapy, hydrotherapy, acupuncture, and, of course, homeopathy. She claims, against all evidence, that acupuncture is really awesome and can be effective against allergic rhinitis, dysmenorrhea, infertility, premenstrual syndrome, and depression, among other conditions. She also claims this about homeopathy:

Homeopathy does not interfere with other forms of medication, is non-toxic, and has little to no side effects. Homeopathic medicines treat a variety of health concerns, including emotional disturbances such as anxiety and depression. It does this my addressing the source of illness not just the symptoms. Homeopathic medicine treats the vital force (known as Qi in Chinese medicine).

I hate to say it (well, no I don’t), but naturopathy is mostly quackery, and the parts of it that aren’t quackery are nothing more than mundane, science-based treatments like diet and exercise, infused with woo and rebranded as somehow “alternative.” There is nothing of value that naturopaths bring to health care that couldn’t be just as easily brought by reimbursing primary care better, so that primary care physicians don’t feel so pressured to see so many patients in such a short period of time. Forcing insurers to pay for pseudoscience and quackery is not the way to solve this problem. The citizens of New Hampshire—indeed, of all states in which misguided legislation like New Hampshire House Bill 351 becomes law—deserve better. They do not deserve legalized quackery. They deserve science-based medicine.