I’m not a fan of naturopathy, which will come as no surprise to any regular reader of this blog. Nor will it come as a surprise that I’m even less of a fan of the “specialty” known as naturopathic oncology. I first noticed that naturopaths were forming this subspecialty back in 2010, when I encountered naturopathic oncology in the context of the “integrative oncology” quackery being offered by the for-profit Cancer Treatment Centers of America, a for-profit hospital chain of dubious repute that was behind pushing the patient-hostile “right-to-try” legislation. I even learned that naturopathic oncologists have their own society, the Oncology Association of Naturopathic Physicians (OncANP) and their own board certification. Those who have this certification can be identified by the letters after their name, FABNO, which stands for “Fellow of the American Board of Naturopathic Oncology”. (Personally, I’ve always said that I think it should really stand for “FAB? NO!”) Of course, given the panoply of dubious therapies, some of them contradictory to each other, that naturopaths use, I really wonder what the certifying test is like. When, for instance, do you choose megadoses of vitamin C over acupuncture or vice-versa? (But I digress.) In any event, naturopathic oncology is, just like all of naturopathy, a medical system based on vitalism, worship of all things “natural” (whether they really are natural or not), and mystical thinking. What naturopaths consider good scientific evidence is not the same as what scientists consider good evidence.
Unfortunately, under the cloak of “integrative oncology” (or, as I like to call it, “integrating” quackery into oncology), despite the mystical magical nature of their specialty, naturopathic oncologists are insinuating themselves more and more into real academic oncology. It’s not just OncANP, which really isn’t a recognized professional society among real doctors. The Society for Integrative Oncology (SIO), for instance, admits naturopathic oncologists as members and has even had two of them as president over the few years. (Oddly enough, even SIO doesn’t seem to know what its specialty entails.) More recently, SIO guidelines for breast cancer care were co-authored by two naturopaths, and the American Society of Clinical Oncology (ASCO) even endorsed these guidelines. So what’s next for naturopathic oncology? Sadly, it’s more legitimization. This time, it comes in the form of the Oncology Association of Naturopathic Physicians: Principles of Care Guidelines.
An article describing these OncANP guidelines was published in Current Oncology. To be honest, I was very disappointed in Current Oncology deciding to publish what is, in essence, a statement of principles by OncANP quacks, but that this journal would publish this paper tells me a lot. Even worse, Current Oncology also published a commentary on these guidelines by a naturopath, Dugald Seely, and Shailendra Verma, a retired physician who used to work at the hospital where Seely works. We’ve met Seely before a number of times and not just in the context of OncANP. He’s the one who helped write the SIO breast cancer guidelines, and he’s also received large grants to study naturopathic oncology from mysterious sources, and cosplays being a real physician-scientist. Not surprisingly, Seely and Verma are very happy about the publication of these new guidelines. Reading their commentary, I couldn’t help but be drawn to this statement:
Naturopathic doctors are trained to understand and endorse the goals and evidence-based outcomes of conventional biomedicine. These professionals are also regulated in many of the provinces and states across North America and have federally recognized and accredited postgraduate training in complementary medicine. The Oncology Association of Naturopathic Physicians (ONCANP) is an organization dedicated to education and research in naturopathic oncology, which advocates for collaboration with conventional providers and is dedicated to advancing the science and application of naturopathic medicine alongside standard cancer care and treatment. The American Board of Naturopathic Oncology (the certification branch of OncANP) supports advanced training in oncology for naturopathic doctors (NDs). Board-certified members are conferred with the status of Fellow of the American Board of Naturopathic Oncology.
Naturopaths are trained to “understand and endorse the goals and evidence-based outcomes of conventional biomedicine”? I laughed out loud at this claim, because it’s hard to imagine a statement about naturopathy that is more disconnected from reality, given that naturopathy embraces homeopathy to that point where it is core topic taught in naturopathy schools and is even part of the naturopathic licensing examination, the NPLEX.
Seely and Verma continue:
The OncANP’s Principles of Care Guidelines delineate a sound ethical and evidence-based approach for NDs who focus on the care of patients diagnosed with cancer. Perhaps most importantly, it provides reassuring insights for other health care practitioners and takes a step in the direction of improving interdisciplinary dialogue. Here is an opportunity to support oncologists, surgeons, NDs, and all health care practitioners to work together to positively transform the care that patients receive in the treatment of their cancer. What is common to all providers is the goal of delivering the best care for patients in a manner that is multidisciplinary, honours patient choice, is scientifically sound, supports the whole person, and achieves the best quality of life for patients.
The problem, of course, is that naturopathy is neither evidence- nor science-based, no matter how much naturopaths try to convince the public and physicians otherwise.. Quite the opposite. It is also not ethical to use quackery, but that’s what naturopathic oncologists—even members of OncANP—are, quacks, something confirmed by a naturopathic apostate, who is being sued by naturopathic oncologists for saying that naturopathy is quackery.
Let’s get back to the guidelines. As is the case with nearly all such “guidelines”, it starts out with an appeal to popularity. In other words, because naturopathy is so popular right now (although it’s arguable whether it really is that popular), naturopaths will provide guidelines to give the people what they want:
The Oncology Association of Naturopathic Physicians (ONCANP) was formed in 2004 to advance the practice of naturopathic oncology, with the goal of improving survival and quality of life for patients with cancer. The profession of naturopathic oncology has grown: approximately 400 ONCANP members are practicing in North America, 115 of whom are board-certified Fellows of the American Board of Naturopathic Oncology. That growth has been fueled by patient demand for integrative cancer treatment options and by an increase in published research documenting the safety and efficacy of natural and supportive therapies. Several studies and meta-analyses investigating the frequency of use of integrative therapies in cancer patients have shown that the prevalence of complementary and alternative medicine use in cancer patients ranges from 22% to 91%.
Naturopathic doctor oncology providers (ND ONCs) play an important role in cancer care, seeking to educate, to help manage side effects of cancer treatment, to improve overall response, to help prevent recurrence, and to optimize health. To achieve positive patient outcomes, ND ONCs use a wide range of natural therapeutics and supportive strategies based on clinical trials, long-standing traditional use, and patient preference. It is essential that patients receive guidance in the use of integrative therapeutic options from high-quality care providers.
Of course, it all depends upon how you define “integrative”. If you include yoga, exercise, and vitamins as “integrative”, of course lots of people can be said to be using “integrative medicine”. If you include prayer and spiritual practices as “integrative”, you can easily come up with a number that’s over 50% of people using “integrative” medicine. Note, also, how the authors conflate integrative medicine with naturopathy, when naturopathy is actually a small part of the phenomenon of integrative medicine. It’s also one of the most pseudoscientific and mystical, as I’ve documented here time and time again.
The authors continue:
The present Principles of Care document is not meant to be prescriptive nor to give providers instructive advice about therapeutic options. Instead, the intention is to ensure safe and effective care by giving clear guidance for the naturopathic management of oncology patients. The document summarizes the key elements that should be present in respect to
- patient assessment,
- an integrative oncology plan,
- naturopathic oncology treatments,
- care coordination, and
- continuing care management.
The Principles of Care Guidelines can also serve as a means for other health care professionals and organizations to understand the naturopathic approach to patient care within the setting of a collaborative health care team.
I find it odd that the authors would state that this document is “not meant to be prescriptive” or to “give providers instructive advice about therapeutic options”. What is it good for, then? It’s basically about as simple—or should I say simplistic?—a set of guidelines as you can imagine. It all seems quite reasonable if you don’t know what naturopathy is. For instance, the part about the patient assessment is downright pedestrian. It lists the constituents of patient assessment, including the medical history and its elements, physical examination, laboratory and diagnostic workup, symptom assessment, psychosocial assessment, and sexual health assessment. There is, however, a hint of the quackery behind naturopathy. You won’t really see it if you don’t know how pseudoscientific naturopathy is, but I’d be willing to bet that SBM readers will see it:
- Conventional laboratory testing should be ordered (or recommended) in addition to any laboratory testing ordered by the patient’s oncologist and should be used to inform diagnosis, response to treatment, and tolerability of treatment.
- Nonstandard laboratory testing (tests that are considered experimental or not part of routine conventional oncology care and assessment) might also be used by the ND ONC in the development of a whole-patient assessment. Such tests are not to be used alone to establish a diagnosis, determine prognosis, or decide on treatment.
Notice the part about “nonstandard laboratory testing”. If there’s one thing that naturopaths like, it’s “nonstandard testing”. They’ll run all manner of unnecessary blood tests, particularly the naturopaths who are into “functional medicine”, which is quite a few of them. Indeed, I once wrote about a case report published by naturopaths about the use of functional medicine to treat an 80-year-old woman with breast cancer undergoing chemotherapy. The number of useless laboratory tests these quacks ran on this poor woman was truly horrifying. Of course, naturopaths not being real doctors and apparently not knowing an adage taught to me beginning early in medical school (treat the patient, not the lab values), these naturopaths tried to correct many of the abnormal values they found.
Indeed, I like to refer to this case report whenever naturopathic oncologists try to convince me that they are practicing science-based medicine, because these naturopathic oncologists practicing “functional medicine” were doing anything but. Indeed, the only things that they did for this patient that might have benefited her included an exercise program, a part time caregiver, individual counseling and group support, and a sleep log. None of these, of course, is in any way unique to naturopathy. Basically, as I like to say, functional medicine is massive overtesting and overtreatment for the worried well that produce reams of useless tests in one hand and a huge invoice in the other.
Of course, as you can tell reading this article enumerating naturopathic oncology guidelines, naturopaths love to represent themselves as “holistic” healers:
Throughout the evaluation process, the ND ONC comes to a full understanding of the health needs of the oncology patient. When referral of the patient for other services or evaluation is indicated, the ND ONC initiates and coordinates the referral and acts to facilitate communication between all practitioners associated with the patient’s care.
Then, later in the paper:
The ND ONC plays an integral role in the multidisciplinary care of a cancer patient. The ND ONC performs a detailed assessment and develops deep contextual knowledge about the patient and their overall health that allows the ND ONC to take a key role in ensuring effective continuity of care in a collaborative team of providers. Continuity of care is rooted in a long-term patient–physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-person perspective efficiently without extensive investigation or record review. The ND ONC, together with the rest of the patient’s health care team, should have the shared goal of providing the highest-quality cost-effective medical care. The ND ONC should cultivate positive health care team relationships by identifying shared treatment goals and developing interprofessional trust through effective, clear communication.
And, in the conclusion:
Because of their training as primary care providers delivering whole-person care, in concert with expertise in integrative oncology treatment approaches, ND ONCs can play an important role in the care of cancer patients. Guiding principles of care are needed if ND ONCs are to be effective players in the larger care team for cancer patients.
That’s right. The authors appear to view the naturopath as the primary care “physician”, who coordinates the care of all the specialties involved in treating the patient’s cancer. That’s a frightening thought. It should be the oncologist, in concert with the patient’s primary care doctor, who plays that role for the cancer patient, not a naturopath. For the authors of this set of guidelines to presume to assert that naturopaths should be the ones coordinating the care of cancer patients is arrogance taken to the nth power.
I must admit that the next passage almost made me laugh out loud:
A primary role of the ND ONC is to assure that the patient makes fully informed decisions about treatment. That assurance includes providing full information about conventional oncology treatment and the inclusion of naturopathic care. Although no individual ND ONC can reasonably know all relevant information about all treatment options, it is critical that the ND ONC provide comprehensive information about the potential risks and benefits of the various strategies they are recommending and, where relevant, reasonable alternatives. In addition, ND ONCs also enhance the patient’s understanding of the risks and benefits of conventional therapies. To solidify that education, the ND ONC should refer the patient to an oncologist for a complete review of their conventional treatment options if the patient has not already received an oncology consultation. When necessary and possible, the ND ONC will refer to other practitioners who can contribute productively to the patient’s comprehensive education and health care.
There’s so much to unpack there. The “ND ONC” has a primary role of assuring that the patient makes fully informed decisions about treatment? That is, of course, impossible for any naturopath to do. The reason is simple. Naturopaths believe that homeopathy works. They believe in a wide variety of quackery ranging from functional medicine to traditional Chinese medicine to various other pseudosciences. Telling a patient that, for instance, homeopathy is a useful treatment to relieve the effects of chemotherapy is nonsense. The only informed consent anyone could provide for homeopathy is to tell the patient that it is water, that it doesn’t work. That’s not what naturopaths tell patients, though. Most naturopaths use homeopathy. Certainly, all of them are trained in it.
Actually, it rather amazes me how much of this guidelines document is taken up with discussions of informed consent. Again, other than the parts of naturopathy that have been co-opted from conventional medicine, such as exercise, dietary changes, and the like, the concept of “informed consent” in naturopathy is one that I find hard to take seriously. For consent to be truly “informed”, it is necessary that accurate, scientifically supported assessments of the efficacy of the treatments proposed be presented to the patient, along with accurate, scientifically supported assessments of the risks of the treatments. Again, for the vast majority of naturopathic treatments, a science-based assessment of efficacy would conclude either that they are ineffective or that their efficacy is unknown. Is that what naturopaths tell cancer patients? Somehow, I doubt it.
Unfortunately, these guidelines documenting naturopathic principles of care is, like all of naturopathy, a sham. It gives this vitalistic system of magical thinking the appearance of legitimacy, the appearance of being real medicine. Unfortunately, as much as naturopaths try to give the appearance that theirs is a legitimate medical specialty, they can’t overcome the fact that naturopathy embraces far more quackery than anything resembling science-based medicine. Cancer patients deserve better. They deserve science-based medicine. They don’t deserve naturopathy. Don’t believe me? Check this video by Heather Wright, the president of OncANP:
That’s right. The president of the organization that came up with these “principles of care” guidelines uses homeopathy every day to treat cancer patients. Any organization that elects a president who uses homeopathy every day in her practice cannot said to be science-based, and any guidelines it produces can safely be ignored. Shame on Current Oncology for publishing this nonsense.