Colorado, naturopathy, and “health freedom”: Devolving into a quack wonderland?

It’s just one more cut on the road to the proverbial death by a thousand cuts.

I’m referring, unfortunately, to last week’s development in the state of Colorado. Specifically, I’m referring to the Colorado legislature’s truly boneheaded decision to license naturopaths, thus giving the imprimatur of the state to quackery and, in essence, legalizing a whole lot of that quackery. It’s been a long time coming, and, say what you will about Colorado naturopaths, they’re persistent and disciplined. As a result, after years of effort, they finally got what they wanted, although apparently not all that they wanted in that they didn’t get the full scope of practice that they wanted. Although some supporters of science-based medicine (SBM) had hoped that the governor might veto the bill, I had little doubt that he would sign it, and sign it he has. Not surprisingly, the American Association of Naturopathic Physicians (AANP) is crowing over this development:

Governor John Hickenlooper today signed into law a measure to allow naturopathic doctors to register with the state to legally practice naturopathic medicine. Colorado becomes the 17th state to do so, along with the District of Columbia.

“I am proud that Colorado has taken the lead in ensuring that well trained naturopathic doctors, appropriately regulated, become a viable health care option for the citizens of our state,” said Rep. Joann Ginal (D-Ft. Collins), the bill’s lead sponsor. Sen. Linda Newell (D-Littleton), the bill’s sponsor in the Senate, commented that “naturopathic doctors are going to be a key component in health care, saving the state millions of dollars through their focus on disease prevention and natural treatment, such as nutrition, lifestyle counseling and botanical medicine.”

Naturopathic doctors are trained to prevent and treat chronic conditions associated with lifestyle – such as hypertension, weight gain, obesity, and diabetes – as well as most other illnesses. The law will enable Coloradans to distinguish between naturopathic doctors and lay or traditional naturopaths, who lack extensive graduate-level clinical training. The law allows naturopathic doctors who have completed a 4-year post-graduate program at an accredited naturopathic medical school and have passed a national science and clinical board exam to register with the state.

If I’ve pointed it out once, I’ve pointed it out a million times (well, actually not a million times, but a lot): Naturopathy is a hodge-podge, a cornucopia of quackery. Indeed, it’s the very essence of “integrative medicine” in that it “integrates” quackery with conventional medicine. Actually, I should put it the other way around. In reality, naturopathy is mostly quackery but co-opts some science-based medicine, sprinkling it on the same way people will spritz air fresheners in a bathroom that hasn’t been cleaned for a while to mask the rancid odor. In the case of naturopathy, that rancid odor comes from quackery and pseudoscience. Indeed, it galls me to no end to hear naturopaths claim that they are some sort of “experts” in nutrition and lifestyle changes. Naturopathy and what SBM says tend to overlap only by coincidence or only because naturopaths have tried to represent parts of SBM, such as diet and exercise, as being somehow “alternative” and part of naturopathy when they aren’t. Meanwhile, as I have described before, you can’t have naturopathy without The One Quackery To Rule Them All, homeopathy, because all naturopaths are trained in homeopathy and homeopathy is even part of the Naturopathic Physicians Licensing Examinations (NPLEX), which is required in states that license naturopaths. Indeed, homeopathy is part of the Core Clinical Science Examination.

That alone ought to tell you all you need to know about naturopathy, but there’s more, so much more, to demonstrate that it’s pure quackery. Ironically enough, the first place I looked to give you some examples is on the very website of the AANP. Specifically, it’s the web page for the 2013 AANP Annual Conference and Exposition, which is being held, appropriately enough given the developments in Colorado, in Keystone this year from July 10-13. Bummer. That overlaps TAM, which means I can’t go, as I’ll be speaking at the Science-Based Medicine workshop, doing a talk to introduce a panel discussion, and, of course, participating in that very panel discussion. Oh, well, I’ll live. To help me, though, look me up if you plan on going too.

But I digress, as I am wont to do.

Let’s compare and contrast a bit. Let’s take a look at what AANP says about itself in its press release about naturopath licensure in Colorad compared to what it presents at its annual conference. First, here’s what the AANP claims about this new law:

“An increasing base of scientific research is affirming that naturopathic medicine is useful in the treatment of numerous chronic illnesses,” observed Jud Richland, MPH, Chief Executive Officer of the American Association of Naturopathic Physicians (AANP). “A good example is the recent study in the Canadian Medical Association Journal, documenting that naturopathic medicine may reduce the risk of cardiovascular disease among people at high risk. Naturopathic medicine, with its emphasis on self-responsibility and body’s inherent self-healing capacity, is effective in many cases of preventable illness, which affect a vast and increasing number of Americans.”

Not surprisingly, I’ve discussed that study before. It’s nothing more than yet another beautiful example of how naturopaths “rebrand” SBM modalities as somehow being “alternative” and part of naturopathy when they are not. More importantly, it is ludicrous to claim that an “increasing base of scientific research” supports naturopathy for the treatment of chronic disease. To help demonstrate that, why not go straight to the horse’s mouth, so to speak, and examine what sorts of “science” is being presented at the annual AANP conference? Let’s take a look at the speaker list, for instance.

One thing that caught my eye immediately is a guy by the name of Glen Nagel, who is billed as “assistant profession and NCNM Zidell Healing Garden Curator” who “teaches Botanical medicine and Naturopathic Vitalism and naturopathic philosophy at NCNM.” For those who try to deny that naturopathy is based on prescientific vitalism, I always find it entertaining to point out that vitalism it taught in naturopathy schools and that there are even classes on it. Vitalism, for those not familiar with the lingo, is the belief that there is something different about living matter such that it contains some non-physical element that animates it, that makes it “alive” rather than inanimate. That element is often given names such as the “vital force,” the “life energy,” or “life force.” In China, it is called “qi,” and that’s why so much of traditional Chinese medicine is considered vitalistic. Acupuncturists, for instance, explicitly claim that sticking needles into certain lines on the body known as “meridian,” through which, it is claimed flows qi, redirects the flow of qi to healing effect. Not surprisingly, here in the West, Samuel Hahnemann, the founder of homeopathy, promoted a vitalistic view of health and disease. Much of so-called “complementary and alternative medicine” (CAM) is a throwback to prescientific vitalism, which has far more basis in superstition and religion than it does in science. Think reiki, which is faith healing substituting Eastern mysticism for Christian beliefs. Think other “biofield” therapies, such as therapeutic touch. Science has moved on, to the point where vitalism is no longer considered a viable belief, much less a viable hypothesis or theory. Yet naturopathy remains rooted in it.

Indeed, at the AANP conference, naturopaths let their vitalistic freak flag fly, so to speak, with a talk by James Sensnig, former Academic Dean and Vice President for Education and Services at the National College of Naturopathic Medicine, the founding Dean of the College of Naturopathic Medicine at the University of Bridgeport, the founding President of the American Association of Naturopathic Physicians (AANP), the former Chairman of the AANP Government Affairs Committee, the founding President of the Institute for Natural Medicine, and Senior Editor on the Foundations of Naturopathic Medicine Project and textbook. That’s right. Mr. Sensnig is not just your average naturopath. He’s a big name in naturopathy. And what’s the title of his talk? “BACK TO THE FUTURE: Why Vitalism is the New Medicine.” It’s described thusly:

Naturopathic medicine cannot simply be understood as being rooted in “Nature”, but rather “Nature” as understood by the vitalist tradition. This world view defines THE difference between the currently dominant school of medicine and naturopathic medicine. It holds that “Nature” is intelligent, orderly and purposeful and that the physician’s role is support the inherent tendency toward order. This view of the universe is beginning to be articulated by the science of our time after coming full circle from a materialistic model. Articulating this paradigm demonstrates that naturopathic medicine and the vitalist thinkers have not only understood the “Laws of Nature” but have presaged by millennia the “New” medicine.

Dream on, Mr. Sensnig. Dream on! The science of our time is most definitely not “coming around” to vitalistic naturopathic views, no matter how much you might wish to present naturopathy as somehow being ahead of its time and SBM as only just now coming around to views embraced by naturopathy.

As for the rest of the speakers, I see very little there resembling science. The closest I see there to any sort of “cutting edge” science is a talk by Mark Davis entitled “Fecal microbiota transplantation.” However, I have no doubt in a naturopath’s ability to woo-ify virtually anything. Disappointingly, there is one real scientist there, Edward J. Calabrese, who is an expert on hormesis, an aspect of pharmacology in which certain dose-response curves can actually show more potent effects at lower doses. Although homeopaths often try to claim hormesis for their own as a justification for their quackery, it is not. What’s really depressing is that Dr. Calabrese appears to be buying into the whole “hormesis as homeopathy” scam:

This presentation provides an assessment of hormesis, a dose-response concept that is characterized by a low-dose stimulation and a high-dose inhibition. It will trace the historical foundations of hormesis and its relationship to homeopathy, its quantitative features and mechanistic foundations, and its risk assessment implications.

Somehow, I doubt that the “relationship to homeopathy” hormesis has will be presented as it really is: Homeopaths deceptively using hormesis as an “explanation” or “rationale” for homeopathy. I’d love it if he did, but I rather suspect he won’t.

As for the Colorado law, Jann Bellamy points out that naturopaths didn’t get the full scope of practice that they wanted, which was to function as primary care physicians. I doubt they’re worried. They’ll be back again and again and again and again until they do get what they want. Count on it. In that they’ll be aided and abetted, no doubt, by a “health freedom” bill that was also signed into law in Colorado. It’s a law that Jann Bellamy has quite appropriately labeled the “quack full employment act,” as it lets virtually anyone practice medicine, as lon as it’s “alternative” medicine.

Truly, in two quick strokes of the pen, Colorado has become a happy home for quacks. Let the Colorado patient beware.