Naturopathy is 80% quackery, 19% science-based modalities like diet, exercise, and lifestyle changes rebranded and infused with woo, and maybe 1% valid medicine. Yes, I know I’m probably being generous given that naturopathy is based on a vitalistic, prescientific worldview and originated in the 19th century German “natural living” movement, but I’m in a generous mood right now. The reason I’m in a generous mood is not because naturopathy has suddenly become less quackery than it was. Just view a few of my posts on naturopathy if you think my opinion’s changed. I still believe that naturopathy is pseudoscience and quackery, and naturopaths are only too happy to confirm that assessment discussing cases with each other when they think no one else is listening.
Naturopathy is, like many forms of alternative medicine, rather religion-like, cult-like, even. Belief matters more than evidence, and being “natural” matters above all else. That’s why it’s refreshing when a member of the cult actually leaves the cult. It’s unusual. Once a person has become a naturopath, it’s rare for that person to leave the pseudoscientific cult that is naturopathy. For one thing, it’s hard—very hard—for a naturopath to switch careers. I’m happy to say that such a thing has happened. A naturopath named Britt Marie Hermes got fed up with the fake medical system that is naturopathy and left. She more than left, however. She turned and started a blog about naturopathy called Naturopathic Diaries, describing her deconversion thusly:
For about 3 years, I practiced as a licensed naturopathic doctor in the United States. In 2011, I graduated from Bastyr University in Washington state and then completed a one-year residency in a private clinic. After my residency, I briefly practiced naturopathic medicine in Arizona.
I left the profession of naturopathic medicine to pursue a career in biomedical research. Since my departure, I have been working to understand my former biases towards naturopathic medicine and explore the ethics and evidence, or lack thereof, of naturopathic philosophy and practice. I’ve concluded that naturopathic medicine is not what I was led to believe. It is a system of indoctrination based on discredited ideas about health and medicine, full of anti-science rhetoric and ineffective and sometimes dangerous practices. This blog reveals what I’ve discovered about naturopathic medicine. Herein lies my story based on my personal and professional experiences.
This is big. This is great. Britt is just what we as supporters of science-based medicine need: a former naturopath who can shed some light on what naturopaths really do. Particularly informative is Britt’s story of why she became a naturopath. It begins with her suffering from psoriasis. Psoriasis, of course, is a disease that is very frustrating for both patients and practitioners. It’s a disease that waxes and wanes, that can be very difficult to treat, and that causes patients considerable distress. But that wasn’t so much the reason why Britt became disillusioned with medicine as it is currently practiced. This is:
My psoriasis story contains the necessary ingredients to reinforce misconceptions and myths about medicine and an attraction to alternatives. First, it paints allopathic medicine as cold and indifferent. The doctor in my story was unmoved by my grief over my diagnosis of psoriasis. He seemed like he was in a hurry. He offered me no sympathies. In my naturopathic bias, he did not care about the patient. He did the most terrible thing ever: he offered me a prescription drug and no other treatment options. (I even asked about other choices.) Lastly, he only treated my psoriasis, not me, the person. I remember that he did not ask about my family history, lifestyle, eating habits, or my spirituality. He stood in the doorway and only treated my disease.
These are classic arguments made by naturopaths to defend their medicine and demonize allopathic medicine. Naturopaths claim to treat the whole person, while medical doctors treat disease. Naturopaths claim to use the least force necessary, while medical doctors push pills. Naturopaths claim to have time for their patients, spending anywhere from 30 to 90 minutes with a patient, while medical doctors spend a mere 60 seconds with a patient. Lucky me, my doctor set me up for a powerful story to validate the use of naturopathic medicine!
In reality, I just got a grouchy doctor. One dermatologist clearly does not represent the entire field of dermatology, and truthfully, I have had many wonderful and warm dermatologists since this experience. But this one psoriasis story cemented my faith in naturopathic medicine, and I used it to convince others of the the miracles of naturopathy.
This is exactly the sort of disillusionment with science-based medicine that leads patients to quackery like naturopathy. I’ve heard the story again and again and again. Unfortunately, the current model of insurance-based reimbursement encourages—nay, demands—the sort of behavior that Hermes’ dermatologist exhibited. With reimbursement barely covering the cost of providing medical services, physicians find themselves forced to try to make a living on volume. It’s true for surgeons, but its especially true for primary care physicians. Spending 30-90 minutes per patient is a recipe for going out of business. Quacks like naturopaths, however, base their model on this. Indeed, as I discussed this very issue earlier this week when I discussed “integrative medicine” as the lure of the shaman-healer.
In fact, Hermes is very explicit about “belief” being central to naturopathy as she continues her deconversion story. And, make no mistake, that’s exactly what it is we’re talking about here, a deconversion story. She describes how doubt began to creep in, describing it as a slow process. First, Hermes encountered practices that to her seemed to portend only small clinical risks, but then, the longer she was in the profession, the more she saw and, as she put it, “began to witness serious and dangerous naturopathic practices.” She then points out that, even though she was a quarter of a million dollars in the hole due to student loans, she had to “drop her faith.” Those are the exact words that she used. She then justified them:
I intentionally use the word “belief” to describe my experiences with naturopathic medicine. Naturopathic medicine is a philosophy, a worldview, and even a lifestyle. It is not a real and distinct medical system. Not everyone has heard of naturopathic medicine, but its principals can be found in any alternative medicine doctrine. In fact, it’s as if naturopathic medicine includes any and all tropes counter to science and borrows loosely from medicine when convenient.
For naturopaths, it does not matter if science refutes the traditional ways of healing. Because for naturopathic believers, what matters is not about what science says, but about beliefs in an alternative, magical healing force. Naturopathic medical beliefs include pseudoscientific ideas like vaccines cause more harm than good, any disease can be successfully treated with homeopathy, alternative cancer therapies are safe and effective, and nutrition can cure mental illness. These beliefs are dangerous and their promotion is unethical.
Yes, as I’ve pointed out so many times before, you can’t have naturopathy without The One Quackery To Rule Them All, homeopathy. It’s part and parcel of naturopathy. It’s in all the curriculae of major naturopathy schools. It’s part of the NPLEX, the naturopathic licensing examination. Based on their belief system that “natural” is always better, naturopaths frequently promote antivaccine views. (I know there has been one naturopath featured on this blog who claimed not to be antivaccine, but even she couldn’t resist seasoning her writing and videos with antivaccine talking points. Not surprisingly, naturopaths contribute to the fear mongering about vaccines and genetically modified organisms (GMOs), the latter of which leads the lack of political will to strengthen vaccine requirements.
What’s amazing, and so much to Hermes’ credit, is that, unlike so many, she actually admitted she was wrong and did so explicitly in her application to the Medical Life Sciences program at the University of Kiel, which is a Master’s of Science program focusing on biomedical research. In particular, she described her deconversion as “getting out of the rabbit hole.”
One of the incidents that turned her on the path of knowledge, noting that naturopaths accuse her of “misrepresenting” the “good” naturopaths who provide what they describe as “high quality care.” As a counterpoint she describes a patient with “multiple chemical sensitivity disorder.” This patient showed up to her clinic for a regularly scheduled intravenous vitamin C and glutathione injection. Because the patient was late for the appointment and his naturopath was unavailable, Hermes had to see the patient to do the IV. She noticed that the patient’s hand was bleeding due to a dog bite.
Hermes wanted to do the right thing after irrigating the wound, namely give the patient a tetanus vaccine and oral antibiotics. This did not go over well with the patient’s regular naturopath:
The patient’s regular naturopath pulled me aside. This naturopath had overheard me consulting the patient and was furious I had recommended oral antibiotics and a vaccine, due to fears of exacerbating the patient’s “multiple chemical sensitivities.” I maintained that the patient had a deep animal bite, the patient was overdue for a tetanus shot, and the likelihood of an infection was pretty good. We debated for several minutes, and when neither of us agreed to change our minds, we decided to disagree and carried on with our tasks. By the time I had returned with the IV bag, this naturopath had spoken to the patient and made a convincing argument against my medical recommendation.
The patient said, “I don’t want oral antibiotics, and I am very afraid of getting a vaccine. Dr. so-and-so agrees with me.”
I had an idea. I suggested the patient apply a topical antibiotic prescription, take home a prescription for an oral antibiotic, and start taking this medication at the first signs of an infection (along with calling me). The patient would also get a tetanus shot on the way home. I helped arrange the vaccination appointment at a local pharmacy and dispensed a homeopathic remedy.
The only way I could convince the patient to get vaccinated was to recommend the homeopathic remedy Thuja, which is a common remedy prescribed by naturopaths for adverse vaccine reactions. When the patient outright refused to get vaccinated, I came up with the idea of using homeopathy to relax the patient’s fears.
So, in other words, in order to do the right thing, she had to trick the patient by doing the wrong thing. Why is that? Because naturopathy is so rooted in prescientific vitalism and pseudoscience that it demands the wrong thing and actively opposes the right thing. Worse, that’s what the patients want. They are drawn to this wrong thing (wrong from a medical and scientific standpoint). As Steve Novella described so accurately, naturopathy is a delusion. As Mark Crislip describes, the ignorance of naturopaths can result in the deaths of patients. As Kimball Atwood described, naturopathy is pseudoscience and prescientific vitalism. As I myself have described, it’s naturopathy versus science, with naturopathy being a a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. 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 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. If you don’t believe me, I could show you a veritable plethora of examples culled from naturopath websites.
Unfortunately, of all the forms of alternative medicine, naturopathy has arguably been the most successful at making a bid for respectability. Indeed, seventeen states, plus the District of Columbia and the U.S. Territories Puerto Rico and the Virgin Islands, license naturopaths. As documented by Jann Bellamy and the Society for Science-Based Medicine, naturopaths are constantly looking to expand that roster. Last year they succeeded (to an extent) in Maryland, but didn’t get anywhere near all that they wanted. They’ll be back, no doubt, to try to remedy that. They’re always back. They tried recently in my own state of Michigan, but the bill appears to have gone nowhere.
Meanwhile, in academia, “integrative” medicine programs integrate the prescientific belief system that is naturopathy with science-based medicine, with depressing results (e.g., the University of Kansas and Georgetown, among others). Professional societies dedicated to “integrative medicine,” such as the Society for Integrative Oncology, allow naturopaths to be full members. Indeed, both the current President and Immediate Past President of the SIO are naturopaths, Suzanna Zick, ND, MPH and Heather Greenlee, ND, PhD. A naturopath helped write the SIO’s recent clinical guidelines for breast cancer treatment. The list goes on. Even though you can’t have naturopathy without homeopathy, the “integration” of naturopathy continues apace.
That’s why Hermes’ contribution is valuable. Indeed, just this morning, she published an Orac-length description of the training that goes into the ND degree. Her key points include that naturopathic education exists in a bubble without any real oversight and that what Bastyr and other naturopathic schools say about themselves and their programs do not jibe with reality. Most importantly, she deconstructs a common deceptive trope repeated by naturopaths to make it appear that their education is the equivalent of that of an MD by detailing what her own education included. Amusingly (and a bit disturbingly), the clinical training in physical examination was risibly lacking:
Students were required to achieve physical exam benchmarks, such as a cardiovascular exam, a respiratory exam, a prostate exam, or a neurological exam. Students were only required to complete one exam in each system and may perform the exam on another student if a patient was not available or the student never had the opportunity to perform the exam on a patient. It was not uncommon for students to perform prostate and gynecological exams on each other in order to complete the required examination for competency. And in fact, the instructor of our advanced gynecology class (an elective course) asked the female students taking the course to act as standardized patients. When I learned this, I was happy that I did not register for the weekend elective course. The lack of actual patients to practice examinations significantly hinders naturopathic clinical training.
No doubt. One wonders how many female ND trainees dropped out of that particular course when they learned that they would be asked to undergo gynecological examinations by their fellow fumbling trainees. (As an aside, I’ve always admired women willing to be standardized patients for medical students. I can’t imagine what it would be like to let a succession of nervous, fumbling students anywhere near my sensitive nether regions, particularly given that they generally are not paid very much and do it more out of dedication to training doctors in women’s health.) In any case, in medical school, a lack of patients is rarely a problem, nor is a lack of supervision. In my year two physical diagnosis class, we had to do complete histories and physicals on a number of patients in the hospital. At the end of the course, our final examination consisted of being asked to do a random part of the physical examination (e.g., cardiovascular, pulmonary, musculoskeletal, neurological) and be videotaped doing it. The videotapes were reviewed by our professors and a major part of our grades. Then, throughout my clinical years (years three and four) and my residency I did more histories and physicals than I can remember, dozens turning into hundreds, and eventually thousands by the time I finished general surgery residency.
Particularly devastating is Hermes’ description of how there really isn’t a standard of care in naturopathy; basically almost everything goes. After all, when you abandon science and embrace modalities like homeopathy and traditional Chinese medicine, there really is no reason other than a combination of ideology and habit to choose one treatment over another for a given tradition. It’s an observation that I’ve made many times before, but it’s good to see it confirmed by a former naturopath, and it’s good to see a description of how there are there were “lengthy competencies for homeopathic medicine” in ND school, to confirm yet again how integral homeopathy is to naturopathy. The American Association of Naturopathic Physicians (AANP) is misrepresenting what naturopathy is to lawmakers in a bid to become licensed. Because the AANP is playing a long game, setbacks are just part of the game. The AANP always comes back again and again and again until it gets what it wants.
In the end, as I described, naturopathy really is very religion-like; so it’s not inaccurate to refer to Britt Hermes as an apostate. She’s put her fellow naturopaths on notice:
Naturopaths are notorious for blindly accepting information that fits their world-view and vigorously ignoring information that contradicts. I’ve seen it many times over.
It is easy for naturopaths to ignore information coming from critical websites and insulate themselves with others who think alike. They read the words “pseudoscience,” “quack” and “show the evidence” and run the other direction. For many years, I did the same, but now I know better. Therefore, I will do better.
To all naturopaths: You are officially on notice.
Let me just publicly welcome Hermes to the world of science and skepticism. I’m very glad she’s here and can’t wait to see her future posts. She’s evidence that, as difficult as it is to dissuade someone so invested in pseudoscience to embrace science, it can happen.