While I am at home preparing for the “perfect storm” – an Autumn hurricane that is barreling down on the northeast –  I found the following letter in my e-mail:

I am appalled at what I am reading. How is integrative medicine quackery? Have you ever visited a Naturopathic Doctor, or an integrative Doctor or practitioner? I bet you know not one thing concerning not only their practice or about what they do to treat diseases. They understand that sometimes pharmaceutical drugs and surgery are necessary, but understand that sometimes they can cause more harm than good.

For some people, not having their nutrients at optimal levels can cause a series of symptoms to exhibit their “deficiency”. For some people toxins do cause problems and therefore need to detoxify. For instance, a cancer patient went to see a naturopathic doctor and found that she was being exposed to large amounts of copper which not only lead to her cancer but also to its persistence. Some people do have food sensitivities that can cause to lymph related cancers.

You may say that nothing that they do is scientific but how can you prove that?

Naturopathic Doctors have always treated people with “Adrenal Fatigue”. You may say that this is not a disease, and that the Adrenals can deal with bountiful amounts of stress. But if Adrenal Fatigue is not a scientifically sound nor is it a disease, then please tell me why has The Journal of Psychosomatic Medicine found that patients with CFS, have an altered Cortisol and DHEA diurnal rhythm? And why has McGill University, a prestigious academic institution, found the same results, as people who suffer from fatigue have altered or varied Cortisol and DHEA diurnal rhythm.

These studies are new studies, but Naturopathic Doctors have been treating them for thirty years or more?

If a Medical Doctor says in their Hippocratic oath that they are to first do no harm, why do they sometimes prescribe medications which at the end causes more harm.

A statin drug was recently taken of the market because although it was approved, they found that it now causes bladder cancer.

Hippocrates said, “Let thy food be thy medicine, and thy medicine be thy food”

If an apple a day keeps the Doctor away, then why don’t we suggest nutrition.

Naturopathic Doctors are unscientific. If the statement be then they would not use blood test and other means to measure biochemical substances and use what they can to treat it.

There is a lot of Journals and Papers published on Orthomolecular Medicine, and CAM. Are these journals not scientific.

The Tripedia Vaccine for Pertussis has been taken off the market. It was noted to the FDA that multiple adverse effects included autism, and SIDS.

If certain drugs can cause carcinogenicities, liver failure, and other nasty side affects why should we take them when there are safer alternatives which can perform the task?

Before you open your traps on making statements that CAM and IM as being  pseudoscientific, go see someone who has treated the ROOT cause of ailments and pathologies.

If you want scientific research I can give them to you!

Sincerely,

This e-mail is very typical. I get some version of it every week or so – the points are not just typical, but positively cookie-cutter. They are popular alt-med memes, what I would call propaganda, that I see over and over again, using almost exactly the same language.  Let’s take the points one by one

“I bet you know not one thing concerning not only their practice or about what they do to treat diseases.”

As a general rule I would avoid making sweeping assumptions about someone or some group with whom you disagree, especially when those assumptions are self-serving. It is perhaps more effective to search for common ground, and to be charitable to the “other side.” If you can effectively argue against the best version of an opposing argument, then your position is likely solid. Otherwise you risk being a straw-man warrior. Regarding this particular assumption, the e-mailer claims to be appalled by what they read (I don’t know if they mean here, at Science-Based Medicine, or both), but they must not have read much. The many articles I and my colleagues have written over several years about so-called “integrative” medicine are pretty overwhelming evidence that we have a detailed knowledge of the philosophy, claims, and methods of all sorts of such practices and practitioners, including the relevant scientific literature.

This particular e-mailer did not play the “pharma-shill” card, but that is also a common assumption on the part of SBM critics. Making such casual and self-serving assumptions dramatically weakens one’s position and argument.

Next:

“They understand that sometimes pharmaceutical drugs and surgery are necessary, but understand that sometimes they can cause more harm than good.”

This is a vague statement, so vague that you can probably say this about most practitioners, except the most extreme (those who disavow all drugs and/or all surgery).  It is true of every physician I personally know, and certainly conventional wisdom within medicine. There is, in fact, a great deal of medical research and reviews directly addressing this question – risks vs benefits of specific interventions. This is the centerpiece of clinical decision-making. Saying that naturopaths understand this and implying that mainstream physicians do not is an absurd straw man.

The real question is – how do the respective professions, and individual professionals, apply the evidence to risk vs benefit decisions. My colleagues and I have documented exhaustively that, on the whole, naturopaths apply the evidence in an ideologically and highly biased way, one that abhors evidence-based practice (even while at times claiming they are evidence-based).  (More on this below.)

For some people, not having their nutrients at optimal levels can cause a series of symptoms to exhibit their “deficiency”. For some people toxins do cause problems and therefore need to detoxify. For instance, a cancer patient went to see a naturopathic doctor and found that she was being exposed to large amounts of copper which not only lead to her cancer but also to its persistence. Some people do have food sensitivities that can cause to lymph related cancers.

“Not having their nutrients at optimal levels” is an odd way to state this, and why the scare quotes around “deficiency?” Perhaps it has something to do with the fact that naturopaths and other dubious “natural” practitioners overdiagnose nutritional issues, because that’s what they treat. To some practitioners all health issues are about nutrition and toxins, because that is their philosophy. The standard medical paradigm, however, recognizes nutritional and toxic diseases, but also infectious, auto-immune, degenerative, anatomical, genetic, developmental, metabolic, psychological, and physiological causes of illness. We recognize and study the influence of diet and lifestyle on health and disease. It is yet another strawman (a demonstrably wrong and unfair one) to claim that mainstream medicine is all about drugs and surgery and for some reason ignores certain disease etiologies. Just read any standard medical textbook, or browse the medical literature, and you will see that this is true.

Naturopaths, however, focus unreasonably, and against the evidence, on nutrition and vague toxins, and then prescribe diet changes and supplements for conditions that are not significantly modifiable with these modalities, or they give “detoxifying” treatments for imagined toxins.

The point about the patient with copper toxicity is just an anecdote. In reality the relationship between copper and cancer is a complex one. Both low and toxic levels of copper can be associated with certain kinds of cancer, but the relationship is not definitively established. Further, lowering copper levels is being researched as a strategy of starving cancers by limiting blood vessel formation. This treatment, however, has been linked with low blood counts and fatigue in cancer patients. In short researchers are looking at every possible angle of copper and cancer and looking at the risks vs benefits of specific interventions. Naturopathy, rather, make assumptions based upon preliminary or cherry picked evidence – whatever supports a nutritional intervention.

Further, non-science-based practitioners will often latch onto preliminary evidence and then run with it, while science-based practitioners recognize that most new treatments or ideas in medicine turn out to be wrong and there is a certain threshold of evidence that should guide practice. Occasionally the preliminary evidence may turn out to be true, and the early adopters can claim to be “ahead of their time” when in fact they were practicing without adequate evidence.

“You may say that nothing that they do is scientific but how can you prove that?”

I actually never claimed that nothing they do is scientific, just that they do not properly use science as a guide to their claims and practice. They may happen to incorporate some science-based treatments, but they certainly do not do so systematically, nor do they exclude treatments that are blatantly unscientific. Naturopaths, for example, use homeopathy – a completely unscientific treatment that is not only as implausible as a treatment can get, but the clinical evidence shows that it does not work. Kimball Atwood has reviewed naturopathy and found:

‘An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices.”

Naturopathic Doctors have always treated people with “Adrenal Fatigue”. You may say that this is not a disease, and that the Adrenals can deal with bountiful amounts of stress. But if Adrenal Fatigue is not a scientifically sound nor is it a disease, then please tell me why has The Journal of Psychosomatic Medicine found that patients with CFS, have an altered Cortisol and DHEA diurnal rhythm? And why has McGill University, a prestigious academic institution, found the same results, as people who suffer from fatigue have altered or varied Cortisol and DHEA diurnal rhythm.

These studies are new studies, but Naturopathic Doctors have been treating them for thirty years or more?

If naturopathic doctors have “always” treated adrenal fatigue, and yet current evidence is just showing that it is legitimate – how did naturopaths know about it? Do they have some magical access to knowledge we should know about? The truth is, there is no convincing evidence that adrenal fatigue really exists. It’s easy to make up a fake illness, then simply proclaim your fake illness to be real and declare victory, while criticizing the mainstream for not recognizing your fake illness. The cherry picked evidence the e-mailer offers does not establish adrenal fatigue as real – not even close. This is, ironically, just another example of how naturopaths are ideological and not evidence-based. If convincing evidence emerges that something like adrenal fatigue exists, science-based practitioners will happily incorporate that into their treatment. If evidence shows that it is not real (as it seems the case to be), will naturopaths drop this idea from their list of things to treat? History suggests no.

If a Medical Doctor says in their Hippocratic oath that they are to first do no harm, why do they sometimes prescribe medications which at the end causes more harm.

Because medical knowledge is imperfect. All interventions have risks, and those risks are statistical. No one can promise (not a naturopath, a homeopath, an acupuncturist – no one) that their interventions will not cause any harm. Even the opportunity cost of seeing one practitioner can potentially cause harm. Again – what matters is risk vs benefit. What we can promise is to use the best currently available scientific evidence to provide the optimal probability of benefit while minimizing risk. Sometimes there is still a bad outcome. Is the e-mailer claiming that the interventions of naturopaths never cause harm? What magic must they have at their disposal?

“Naturopathic Doctors are unscientific. If the statement be then they would not use blood test and other means to measure biochemical substances and use what they can to treat it.

There is a lot of Journals and Papers published on Orthomolecular Medicine, and CAM. Are these journals not scientific.”

Because they are pseudoscientific. Using the trappings of science, like blood tests, does not make a practitioner scientific. Following scientific evidence and methods make one scientific, and as a whole the naturopathic profession is not science-based in their practice. Having a journal is just another trapping of science. If the editorial policy of the journal is not adequately science-based, then no, that does not make them scientific.

The Tripedia Vaccine for Pertussis has been taken off the market. It was noted to the FDA that multiple adverse effects included autism, and SIDS.

Before you open your traps on making statements that CAM and IM as being  pseudoscientific, go see someone who has treated the ROOT cause of ailments and pathologies.

This is a common CAM meme – that CAM practitioners treat the “root” or real causes of disease, while mainstream doctors only treat symptoms. Treatment modalities used by naturopaths and CAM practitioners and not by mainstream science-based practitioners do not treat real causes of disease. They treat fantasies with magic and fairy dust. They base their claim on their own made-up causes of disease. Naturopathic treatments, like homeopathy and acupuncture, are vitalistic practices that are based on ancient superstitious notions of an imaginary life energy – not on real “root” causes of illness.

Conclusion

The above claims are depressingly common among CAM believers. They are demonstrably wrong and most of them do not even make logical sense. They collapse under any level of scrutiny.

It is important to recognize that the SBM criticism of CAM is based upon their own claims and writing. They can make their best case for their position – it is simply not based on a fair and reasonable assessment of the scientific evidence, and it frequently involves blatant abuses of scientific methods.

Meanwhile the anti-science and mainstream medicine propaganda from the CAM side is a demonstrably false and unfair strawman. I suggest the e-mailer take their own advice and find out what mainstream medicine is all about from primary sources, rather than secondary hostile sources with a marketing agenda.