I’ve frequently lamented the infiltration of pseudoscience into academic medical centers and medical schools, so much so that I often refer to this unwelcome phenomenon as “quackademic medicine.” It’s a phenomenon that is not well-appreciated, although there has been some fitful recognition from the press of late. Basically, quackademic medicine involves the adoption, practice, sale, teaching, and study of highly implausible alternative medical interventions, such as homeopathy, naturopathy, and acupuncture, as though they had scientific plausibility and might actually be efficacious, and, as I’ve documented since not long after the beginning of this blog. Particularly galling to me is just how much such quackery has found a home in oncology, even in National Cancer Institute-designated comprehensive cancer centers (NCI-CCCs). In particular, I’m disturbed by how accepted the quackery that is naturopathy has become in oncology, even to the point where two naturopaths have served as past presidents of the Society for Integrative Oncology (SIO).
Naturopathy is, of course, quackery. Of that there is no doubt. I’ve shown numerous examples of this over the years, particularly when you look at what naturopaths say to each other when they think no one’s listening. The quackery they practice is depressingly epic. Sadly, though, naturopaths are enjoying some success in fooling state medical boards to license them as legitimate health care providers, even though they are antivaccine and you can’t have naturopathy without homeopathy (The One Quackery To Rule Them All). Basically, naturopaths are fake doctors cosplaying real doctors. They don’t know their limitations. It’s almost as though they think theirs is a real medical specialty.
Naturopaths are even starting to subspecialize. Indeed, they’ve even created a “specialty” known as naturopathic oncology, complete with a suffix to put after their name and “ND” (not a doctor) title, FABNO (which I like to refer to as, “FAB? NO!”). At first, FABNOs were confined mostly to bit cities and academic medical centers, but yesterday I learned that it appears that naturopathic oncology is now metastasizing to smaller community centers:
The Gundersen Health System in La Crosse, Wis., for example, has offered integrative medical services for the better part of a decade. Its integrative care services has especially grown in the last couple of years, and is now offered at six of the health center’s locations.
“We have traditional healing and herbal therapists who have agreed to work with our clinic, and they’ve agreed we share the patient,” said Jeffrey Landercasper, MD, a general and breast surgeon affiliated with Gundersen. “We’ve been able to keep patients who said they were leaving.”
In some centers, such as Northwest Surgical Specialists (NWSS) in Eugene/Springfield, Ore., naturopathic doctors participate at tumor board meetings, an approach for involving integrative care providers that was discussed during a panel session at the 2017 annual meeting of the American Society of Breast Surgeons by Winnie Henderson, MD, a general and breast surgeon at NWSS.
“I’ve never heard of anyone else doing that. It’s a novel idea that I think ought to be investigated,” Dr. Landercasper said.
No, it is not. It is a horrible idea, and oncologists should have stomped that sucker flat the first time a naturopath or woo-prone oncologist suggested it. I attend our breast cancer tumor board every week. There is absolutely nothing of value that naturopaths can add to the multidisciplinary discussion of patients and how best to care for them. None of this means that we don’t discuss strategies to improve patients’ quality of life. That’s the con that naturopaths use to insinuate themselves into legitimate cancer care: That only they care about diet and lifestyle modifications and that they are somehow uniquely qualified to address these issues. They are not. Worse, naturopaths’ counseling about science-based lifestyle interventions like diet and exercise comes with a price, and that price is that quackery inevitably accompanies any science-based interventions. Naturopaths use all sorts of quackery, ranging from homeopathy to functional medicine to bogus allergy testing to traditional Chinese medicine to more forms of nonsense than I can recount. It makes me wish that I had attended the American Society of Breast Surgeons meeting earlier this year, so that I could have attended that panel discussion. Oh, well, maybe next year.
The article next trots out Heather Wright, president of the Oncology Association of Naturopathic Physicians (OncANP), who of course is all for this new model. So does Michelle Niesley, a naturopath with the Clinic of Natural Medicine, in Eugene, OR:
“A lot of people have no idea what a naturopath is,” Dr. Niesley said. “Many doctors aren’t aware that we go through a four-year postgraduate program, and that there are hospital-based residencies in integrative medicine for naturopathic doctors.”
At these multidisciplinary meetings, integrative care providers can present research in their area, which “allows other team members caring for the patient to hear the rational and evidence base for the supportive care offered by naturopathic doctors,” Dr. Wright said.
Often though, Dr. Niesley said, integrative care providers usually are simply there to answer questions. “We listen to the cases and provide clarification. For example, if a patient has asked an oncologist about some sort of alternative treatment that the oncologist is not familiar with, we can provide evidence-based information.”
“Evidence-based information.” You keep using that term. I do not think it means what you think it means. Naturopathy and evidence-based information are related only by coincidence. Indeed, more often, naturopathy embraces exactly the opposite of science- and evidence based practice. Including naturopaths in a tumor board of necessity requires injecting quackery and pseudoscience into those boards.
Another argument made for this sort of arrangement is this:
But the educational aspect goes both ways. Dr. Henderson and her colleagues began inviting local naturopathic oncology providers to tumor boards in an effort to form an alliance with the integrative care providers they knew their patients were seeing or thinking about seeing.
“We want the naturopathic providers to know what happens when patients follow, or don’t follow, a certain path of care—or instance, what happens as a result of delayed treatment,” she said.
There were numerous situations, Dr. Henderson said, in which newly diagnosed patients who turned to alternative therapies as a primary treatment returned with tumors that had grown to the point of requiring a salvation mastectomy or had metastasized.
“Instead of shutting out integrative care providers, we want them to know why we might suggest one treatment plan over another,” Dr. Henderson said. “For patients with triple-negative breast cancers, time is of the essence. These are situations in which it’s important for the naturopaths to refer patients back to us for the aggressive treatment some patients need.”
There is a germ of a point here. Alternative medicine kills cancer patients. It is deadly for cancer patients. I can say from my own anecdotal experience is that pretty much every patient I’ve seen with large, ulcerating, fungating breast cancers resulting from patients delaying effective treatment in favor of pursuing alternative medical treatment received their quack treatments from naturopaths. Fortunately, the number over the years has been relatively few, which, unfortunately, means that I can’t draw much in the way of conclusions from this observation.
The point is that many naturopaths tell patients that they can cure their cancer naturally and without all the toxicity of chemotherapy, surgery, and radiation. Such naturopaths do not accept their profession as being in a subsidiary role to standard medicine; they really believe they can treat cancer “naturally.” As a result, the sorts of naturopaths likely to be influenced by this education are very likely not the naturopaths out in the community killing cancer patients by delaying their seeking effective care. In other words, naturopaths who are content to be “integrative” instead of being in charge are the ones who least need the lesson. Again, naturopaths don’t know their own limitations.
Here’s another bad idea:
Another model for alignment with integrative care is to bring those providers into the practice setting, giving patients the opportunity to meet with both their standard care providers—their surgeon and oncologist—as well as naturopathic doctors.
“In the tumor board setting, you have the naturopathic doctor explaining the patient’s reported symptoms and condition along with their desire for a natural or holistic approach to the conventional treatment team. In the practice setting, the integrative provider can explain and reinforce to the patient the benefit of the treatment offered by the surgeon, medical oncologist and other providers,” Dr. Wright said.
Notice how this model presents naturopaths as being equal to real physicians, such as oncologists, surgeons, and radiation oncologists. Again, this model depends on finding naturopaths who actually accept that chemotherapy, surgery, radiation therapy, and targeted therapies are valid treatments that work better than their quackery, which brings me to this:
Dr. Wright and Dr. Niesley recommend practices searching for a naturopathic oncology provider consult the OncANP, which has a list of licensed NDs with specialty training in oncology care listed by location (https://oncanp.org/?). “It’s not a complete list of doctors who practice integratively, or for other integrative providers, but it’s a great place to start,” Dr. Niesley said.
I’ve done this sort of activity before, using websites affiliated with organized naturopathy to look for licensed naturopaths and then seeing what they offered. The results were not pretty. Really, they weren’t. Because naturopathy is quackery, endorsement by a naturopathic “professional organization” does not mean a lack of quackery. The quackery is “baked in” to naturopathy.
So I did the same thing with Oregon and found similar results. For instance, the Sage Cancer Care clinic touts liver “detoxification” to deal with chemotherapy. Another, the Amber Wellness Group, offers IV therapies that include high dose vitamin C and chelation therapy for heavy metal and treats the fake disease known as chronic Lyme disease. They offer nonsense such as mistletoe therapy, “hormonal, neurotransmitter and adrenal optimization,” “genetic analysis in regards to methylation pathways,” and, of course, that absolutely unavoidable favorite of naturopaths, “detoxification.” They also use Doctors Data to do all sorts of dubious provoked heavy metal testing, and run tests for “chemical exposures.” Meanwhile, Dr. Niesley goes on about “biochemical individuality“:
At the Clinic of Natural Medicine we treat you, not your condition. We believe that whatever your disease or condition may be, it is a manifestation of underlying imbalances in your body. Determining these underlying imbalances is an essential step in correcting them. This is achieved through a thorough consultation (our first visit is often one hour in length), a review of all conventional testing (blood work, pathology reports, imaging, etc.), a physical/nutritional exam, and further testing if indicated (conventional or non-conventional blood work, salivary, fecal or urine analysis). This may even include analysis of your genomics, which tell us at the most basic of levels how your process certain nutrients or break down substances your body manufactures, like hormones, catecholamines, and neurotransmitters.
Sounds like functional medicine quackery to me. In any case, you get the idea.
What was particularly annoying about this article is that there wasn’t even a token skeptical voice included. The writer interviewed naturopaths, and she interviewed physicians who think it’s a good idea to “integrate” naturopaths into conventional medical care. Naturopathy is presented not as the quackery that it is, but as a valid equal to conventional medicine and the observation that, more and more, community hospitals are “integrating” naturopathic care with conventional medical care as a positive development.
It’s not. It’s the exact opposite.