Resurrecting old tropes about naturopathy

Back in the before time (you know, before COVID-19 arrived three years ago), I routinely used to address dubious arguments that naturopaths made about their medical pseudospecialty. Because I’m a cancer surgeon, what most irritated me about naturopaths were how these quacks falsely claimed expertise in oncology (even pediatric oncology), a problem that has over the years led to my seeing a (fortunately) small but (unfortunately) steady stream of patients whose breast cancers would have been easily treatable when diagnosed but had been allowed to grow to become locally advanced or even metastatic because they had wasted time—sometimes years—being treated by naturopaths. Of course, it’s not limited to just cancer, but the increasing acceptance of naturopaths in academic medicine, to the point where some hold senior faculty positions in, for example, a department of family medicine at a very reputable medical school, where they invite homeopaths to lecture residents and medical students.

If there’s one thing that naturopaths (and other quacks) have argued over the years, it’s that they somehow add something to conventional medicine when they are included as part of “integrative medicine.” Unfortunately, they’re still at it, and their arguments are no more convincing today than they were before the pandemic. That doesn’t stop them from continuing to publish articles asking questions like, Does naturopathy offer a lifeline for our burned-out health system? (Betteridge’s law of headlines most definitely does apply there, although I’m sure that the writer, Robin Roberts, didn’t intend to invoke this famous law.) The blurb tells you where this article is coming from:

In a time when many Canadians don’t have access to a medical doctor, naturopathic doctors can help fill the void and ensure that the cycle of care remains intact.

You’d think that a country like Canada, which has universal single-payer health insurance, would be less prone to arguments like this given that many fewer Canadians lack access to healthcare than Americans, but that never stopped naturopaths before. So let’s see what they’re saying now. As is often the case with dubious arguments touting naturopaths, this article begins with an anecdote:

When Ron Downie’s sister, Carrie, was undergoing treatment for blood cancer, he felt he was in a unique position to help. As manager of a vitamin and supplement store in Abbotsford, B.C., he had several customers, also grappling with cancer, who told him they were thriving on a type of mushroom used in traditional Chinese medicine called turkey tail (coriolus versicolor). He suggested Carrie try the funny sounding fungus, which is said to be packed with antioxidants that enhance the immune system. After several weeks, he says, her blood work was so good that even her doctors were “blown away.”

“Blood cancer”? Which one? There are so many, and it makes a huge difference which one. For example, if this “blood cancer” is something like chronic lymphocytic leukemia (CLL), which tends to progress slowly and might not even need treatment at all at first, and is something that people often die with rather than of. What “blood work”? Which tests?

As for coriolus versicolor, the Memorial Sloan-Kettering Cancer Center (MSKCC) website notes this:

When used as an adjuvant, PSK appears to improve survival rates in patients with gastric ^(1) (2) and colorectal ^{(3) (4) (5)} cancers. It may also benefit patients with esophageal cancer ⁽²⁷⁾. Findings from a study of PSP in conjunction with chemotherapy suggest benefits in patients with advanced non-small cell lung cancer ⁽⁶⁾. PSP was also reported to act as a prebiotic and to modulate human intestinal microbiome composition ⁽³⁰⁾. Studies of Coriolus extracts alone or in combination with other botanicals suggest positive immunomodulatory effects ^(7) (8). However, data on their effects on breast cancer ⁽⁹⁾, hepatocellular carcinoma ^(10) (28), or leukemia ⁽¹¹⁾ are mixed. A meta-analysis reported reduced mortality risk with adjuvant use of Coriolus across a variety of cancers ⁽²⁹⁾, but confirmatory studies are needed.

One notes that these studies generally use a derivative of coriolus versicolor, Polysaccharide-K (PSK), a proprietary product derived from coriolus, was developed for cancer treatment in Japan. That means that what we’re looking at, if PSK turns out to be effective against certain cancers, is nothing more than pharmacognosy, a long-established branch of pharmacology in which natural products, their derivatives, and molecules isolated from them are studied to determine whether they have medicinal properties. It’s not as though many medicines discovered through the science of pharmacology aren’t natural products. I like to point to taxol, for instance, which is now used to treat a number of cancers and was first isolated from the bark of the Pacific yew tree. However, naturopaths—and other advocates of supplements and “natural medicine”—love to portray herbal medicine as though it is some sort of magic. You might remember several years ago when the discoverer of Artemisinin, which is used to treat malaria, won the Nobel Prize in Physiology or Medicine and advocates of traditional Chinese medicine (TCM) seized on the prize to claim that it somehow “validated” all of TCM when it did not.

As for coriolus versicolor (or PSK or whatever extract of coriolus is used), the studies cited in the MSKCC review were not particularly compelling. For instance, this study of adding PSK to standard-of-care chemotherapy showed a barely statistically significant improvement in survival from gastric cancer. Other studies show a significant survival benefit to adding PSK to chemotherapy for certain cancers, mainly after curative resection of solid tumors. None of these studies, even if validated, would be evidence suggesting that the compound on its own would be effective in treating blood cancers.

I also note that Roberts saved a very important piece of information, namely how the anecdote has turned out thus far:

As for Carrie’s use of turkey tail, her blood work today is not as good as it was six months ago, despite consistency with her diet and exercise. And while Downie acknowledges that he has heard from countless people about the benefits they have experienced taking the supplement, he also believes that it’s not the only thing that makes positive change happen. Also playing a role is the combination of different lifestyle and diet choices, as well as the fact that no one person experiences recovery the same way.

“It’s important that people understand that every person is different and will get different results,” he says.

So the super positive anecdote that the story started out with wasn’t so super positive after all, was it? But don’t worry. it must have been something else, like the patient not eating the “right” diet and living the “right” lifestyle, and if it wasn’t that, well, everybody’s different, right?

Consistent with these sorts of narratives, Roberts pivots to an appeal to popularity, a.k.a. the logical fallacy known as argumentum ad populum, in order to write:

According to a study conducted in 2016 by the think tank Fraser Institute, more than three-quarters (79 per cent) of Canadians had used at least one alternative therapy over the course of their lives. A 2015 Canadian Community Health survey showed 38 per cent of men and 53 per cent of women overall used vitamin and mineral supplements. And a previous U.S. study reported that those rates among cancer patients shot up as high as 81 per cent.

I’ve written before about how such studies tend to be custom-made to exaggerate the use of supplements or or various alternative medicine modalities. I’m not going to belabor that point here because, even if the numbers above are absolutely accurate, they don’t justify this utter facepalm of a conclusion:

All the more reason that any advice and recommendations come from a licensed and regulated health-care professional, such as a naturopathic doctor (ND).

I realize that naturopaths are licensed in some states and (apparently) Canada too. While that might make them “healthcare professionals” in the eyes of the law, it does not change the fact that naturopathy is quackery and that naturopaths practice quackery, as one can easily see when one looks at the sorts of things they discuss when they think no one is looking. Naturopaths are also rabidly antivax, so much so that the only provaccine naturopaths I’ve ever encountered either turn out not to be so provaccine when examined more closely or no longer practice naturopathy, having left because they had an epiphany and realized that they could no longer be quacks and look at themselves in the mirror. So let’s just say that naturopaths might think that they are “healthcare professionals” and “experts,” but theirs is a pseudoexpertise based on prescientific mysticism, pseudoscience, and quackery. Also, as I like to say, you can’t have naturopathy without The One Quackery To Rule Them All (homeopathy) because homeopathy is such an integral part of naturopathy that it is on the NPLEX, the naturopathic licensing examination.

Not that that stops Roberts from citing what naturopaths claim about their specialty:

The Canadian Association of Naturopathic Doctors (CAND) describes naturopathic medicine as a blend of modern scientific knowledge and traditional and natural forms of medicine and encompasses everything from acupuncture, traditional Chinese medicine, hydrotherapy, homeopathy, botanical medicine and clinical nutrition.

“If someone is undergoing conventional cancer treatment, we’re there to support them by helping improve their quality-of-life symptoms,” says Dr. Mark Fontes, naturopathic doctor at Insight Naturopathic Clinic in Toronto and Chair of CAND. “[That includes] improving sleep and appetite, reducing muscle pain [through] dietary interventions, herbal medicine, targeted supplements, minerals and vitamins. “We’re highly trained in managing chronic disease, from inflammatory bowel disease, to Lyme disease, chronic pain, digestive and hormonal concerns.”

Fontes says naturopathic doctors work collaboratively with major hospitals, family doctors and oncologists to offer supportive care before, during and after conventional medical treatment.

I note right there that naturopaths admit that they are quacks without admitting they are quacks. Look at all the quackery! And look at all the quackery on not-a-Dr. Fontes’ website! Acupuncture, intravenous vitamins, infrared sauna therapy, low intensity laser therapy, and more! As for “individualization,” well:

“It’s about individualized care,” says Fontes. “We might see five patients with an acute viral infection or migraine, and they’re not all going to leave with the same plan, depending on their current health status and medical history.”

What this suggests to me is not so much “individualization” but making things up as they go along. Conventional evidence-based medicine individualizes treatments based on diagnosis, health status, and history; naturopaths can treat patients with the same condition using wildly different treatment plans.

The narrative being pushed by Canadian naturopaths and parroted by Roberts is an old one. It’s one I’ve been countering almost since I first discovered what naturopathy is. Naturopaths have long fancied themselves to be “real physicians,” as well as being qualified to be primary care doctors. They are qualified to be neither. Quite the contrary. Unfortunately, their narrative resonates, which is why so many states have fallen for it and licensed naturopaths, and Canadian naturopaths are no different in these delusions.