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Naturopaths and march of pseudoscience

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Ontario naturopaths are pushing hard to become a self-regulating profession with expanded rights to prescribe drugs and order tests. Thankfully, the Ontario Medical Association is pushing back.

This is not a turf war -- there are more than enough patients out there. Nor is the resistance from the medical community founded on a fear of a loss of professional status. This is about patient safety and, more fundamentally, the role of science in the Canadian health-care system. Naturopathic medicine, despite its claims to the contrary, is not evidence-based. Given this reality, health departments need to carefully consider the long-term implications, including the legal and ethical challenges, of formally legitimizing the pseudoscientific.

If naturopathic medicine were governed by science, as practitioners increasingly claim, they would not provide detoxification services, homeopathic remedies, most herbal remedies and cosmetic facial acupuncture. But these types of services are the core of naturopathic medicine. If you don't believe me, I invite you to Google "detoxification and naturopath." You will get a list of clinics offering things such as colon cleanses (useless, potentially harmful and a bit disgusting), ionic foot baths that create an "energy field similar to that found in the human body" (so scientifically ridiculous it borders on parody), and infrared sauna therapy (ditto).

Lucky for naturopaths, they are not bound by science. I do not mean the laws of physics do not apply to the things that happen within the walls of naturopathic clinics. I am fairly certain an apple will still fall, the Earth still orbits the sun and the application of the scientific method would still nudge us closer to the truth about the therapies they deploy.

Rather, I mean the profession is not wedded to a scientific world view. It is a practice built around a philosophical framework based on the alleged healing power of nature or, to quote the Canadian College of Naturopathic Medicine, the "principle of healing through the co-operative power of nature" and the "individual's inherent self-healing mechanisms." This kind of rhetoric may sound inviting, but it is scientifically meaningless.

What naturopaths increasingly suggest is that they are in a position to integrate the best of both conventional and alternative practices. They can, or so they claim, slide between the worlds of pseudoscience and science. They can offer ionic footbaths and, at the same time, push provincial governments for the right to provide patients with more conventional, and potentially harmful, procedures and drugs.

Putting aside the boatload of conceptual and patient-care issues associated with legitimizing magical thinking (the recent death of a seven-year-old Alberta boy who was given homeopathy instead of real medicine is a tragic example), there are many profound and often overlooked legal and ethical challenges associated with seeking to integrate a pseudoscience-based practice into our health-care system.

To cite just one example, how will the informed-consent process work? In Canada, health-care providers must tell patients anything a reasonable person in the patients' position would want to know. As such, a science-based approach to the provision of a homeopathic remedy would require the practitioner to tell a patient that other than a possible placebo effect, the treatment does not work and is scientifically implausible. Any other approach would be unethical and fail to meet the legal standard of informed consent.

I call this the two-hat fallacy. A naturopath can't, from the perspective of the patient, switch between wearing a science hat and pseudoscience hat. If you are a science-informed profession, this is the standard to which you should be held. Which hat will they be wearing if naturopaths are given the opportunity to provide potentially lethal drugs?

Of course, there are also problems associated with naturopaths' knowledge of and approach to science. For example, a U.S. study found only 24 per cent of naturopaths found the "results of randomized controlled trials as 'very useful.' "

I am fully aware of the many deficiencies of conventional medicine, including the perverting influence of commercial forces and the lack of good evidence to support many common practices and therapies. Also, many Canadians are not satisfied with their interactions with conventional practitioners, which they find too brief, mechanical and impersonal. These issues need to be addressed.

But the response to the problems of conventional medicine should not lead us to embrace pseudoscience. As nicely summarized by well-known science advocate Ben Goldacre, a flaw in aircraft design does not mean we should turn to magic carpets.


Timothy Caulfield holds the Canada Research Chair in health law and policy at the University of Alberta. This article was originally published on healthydebate.ca

Republished from the Winnipeg Free Press print edition December 18, 2013 A9

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