In a recent editorial David Brooks makes the point that privacy is important and we should not relinquish it lightly. Among other benefits of privacy, he states:
There has to be a zone where half-formed thoughts and delicate emotions can grow and evolve, without being exposed to the harsh glare of public judgment. There has to be a place where you can be free to develop ideas and convictions away from the pressure to conform.
I agree with this. The law also recognizes this, which is why there is automatic privilege between married individuals. This also came up in discussions of whether or not conversations between the president and his advisers should be private or public, with many making the point that the public’s interests are probably best served if their advice were candid and uncensored. We also recognize the need for attorney-client privilege and the confidentiality of the physician-patient relationship.
At the same time there are benefits to transparency and there are situations in which the public interest is best served by open discussion, even leaking information that some would want to keep private. For example, government communications at some level should be transparent, hence the mini-scandal surrounding Clinton’s e-mails. Courtroom testimony is public, but the deliberations of the jury are private.
Science is one of those things that should be, in my opinion, completely transparent and public. An individual scientist is free to keep their private thoughts private, but scientific deliberations, publications, research, and policy should be not only public but easily accessible.
The same goes for professions, because they have a contract with society – they are granted certain privileges in exchange for accountability and standards. This is especially true of a profession that is ostensibly based on science.
This is why I think the leak of conversations among naturopaths in a private Yahoo! Group named Naturopathic Chat, in my opinion, was a good thing. Naturopaths are requesting, and have been granted in many states, the privilege to be health care providers, and claim as part of their request for such privileges that their practices are scientifically valid. Their beliefs and health care practices are therefore very much a matter of important public interest.
They sell themselves as adequately trained in both “natural” and conventional medicine, but I do not believe this is true. Their training is mostly in pseudoscientific nonsense and it does not prepare them to be science-based health care practitioners. They have brought this issue to the public domain, and therefore it should be public and transparent. In my opinion naturopaths try to put their best foot forward when talking to academics and politicians, and are coy and evasive when it comes to the depths of the pseudoscience at the core of the beliefs and practices. Hearing them talk in an unguarded environment, therefore, is very enlightening.
At science-based medicine mostly what we have endeavored to do regarding naturopaths is to simply make the public aware of naturopathic training, philosophy, and practice. For this purpose, the NatChat leaks have been gold. David Gorski already wrote about these leaks at SBM. In addition I recommend the series of articles by a former naturopath about their training and practice.
If you are interested, then I highly recommend you read through some of the threads on NatChat. When I did, a few themes emerged.
One is that naturopaths place great weight on anecdotal evidence (sometimes referred to as “n of 1″ evidence, to make it sound more scientific). It is, of course, okay for practitioners to share their experiences with individual patients, as long as those experiences are not confused with evidence for the efficacy of a specific treatment. Individual experience is useful for informing the use of treatments that have already been proven to be effective with rigorous scientific evidence, or to generate hypotheses to be tested rigorously. They should not, however, be presented as evidence for efficacy.
Another common theme is that it seems to me many of the naturopaths in the chat room believe they are being scientific in their approach. They read research papers and cite often sophisticated biochemical or physiological justifications for their treatments. They are consistently committing a grave error, however. They grossly overestimate the degree to which basic science knowledge can predict that a treatment will work.
Basic science uncovers many potential mechanisms that can be exploited for possible treatment. The problem is that most of those mechanisms will not pan out when studied clinically. One 2005 review looking at reported potential new therapeutic targets found that 20 years later only 1 out of 101 were in widespread use, and only 5 had lead to any products.
Naturopaths go beyond looking at individual therapeutic targets, and tend to make wild speculations that involve many links in an increasingly unlikely chain. This would not be a problem if all they were doing is spitballing for new potential research projects, rather than using their speculations as the actual basis for treatments.
The third theme that clearly emerges is that naturopathy is heavily philosophy-based, rather than science-based. They have their beliefs and their philosophy, and that is what guides their treatments, rather than a rigorous application of the best science.
Let’s give some examples to illustrate these points. In a thread on vaccines, one naturopath writes:
“I said forced vaccinations are the most important civil liberties issue of our age, not the most important issue. I did not compare it to racism, poverty, homelessness. Because it is a forcible assault on innocents, in fact, on the majority of children, attempted on all children, it is arguably the most important civil liberties issue of our age. If you cannot control or prevent what others choose to insert into your body, how is that substantially different than rape? Without emotional rants, please compare the legal definition of rape to the mechanism of vaccine administration against the recipient’s will, and to the unsuccessful prevention of penetration of one’s own body by another person or by an instrument used by another person.”
They follow a philosophy of freedom over standards. Perhaps as part of this, they have a large anti-vaccine culture within their profession, but are not always open about this. Here we see a naturopath comparing vaccination to rape. Of course, no adults are given forced vaccinations, and no children are vaccinated against the will of their parents. The state mandates vaccines only in that they make it a requirement for certain things, like entering public school (and even there often allowing exemptions).
Regarding ebola, one naturopath helpfully wrote:
“So I put up a website this weekend (bare bones) were one can download a PDF with all research summaries of what I found and possible treatment strategies. Inhibition of cytokine storm also has more immediate relevancy in case a virulent stain of avian flu begins to circulate. I am charging $7 a copy, as I have put almost 150 hours into this over the 2 months and incurred expenses setting up the website. www.ebolastorm.co”
Essentially he looked through Pubmed for research from which he could wildly speculate about “natural” therapies.
Here is an interesting discussion about when to refer to an MD:
I have a patient who I am concerned has leukemia. I have never made this diagnosis before and am looking for guidance. This patient is un-insured and not interested in seeing a MD unless absolutely necessary.
What follows are statements that ND’s are primary care gatekeepers and need to know when to refer. One reply states:
I find I hesitate to call in cases like these because it feels like asking favors from a busy and reputable stranger.
On another note, I would hold off on adding folate until cancer is ruled out. Also hematologic cancers are different than solid tumor cancers in many ways and certain supplements should be avoided (melatonin etc….).
I would also refer to onc in this case but with the understanding that the referral is only for information gathering and nothing more.
Was that “good luck!” for the ND or the patient? Keep in mind, this is a patient with possible leukemia, and the ND has never seen a case. Not referring (even for a physician) to an oncologist with expertise in the diagnosis and treating leukemia is malpractice. To be fair, another ND in the discussion did recommend referral to oncology, but was advocating the ND as primary care gatekeeper.
Here is another discussion in which an ND recommends using a rife machine (which is a fake treatment) for chronic Lyme (which is a fake illness):
I treated chronic Lyme disease for several years, and will have to say that I was very impressed by the Rife machine. I used it on every patient, and saw exactly what I would expect with a therapy that kills the bugs: Herx following use of Rife, sometimes quite dramatic, with resolution within 2-5 days depending on the patient. I cycled through 4 different sets of frequencies focusing on different aspects of the Borrelia life cycle, co-infections, etc.
It is interesting to see a range of opinions expressed, and some NDs in the thread did correctly characterize the rife machine as “pure fantasy.” So there seems to be a wide range of opinions, reflecting the lack of a consistent standard of care.
We are just scratching the surface of this vast document. It is nothing new, in that you can find documents discussing naturopathic treatments which are based on pure nonsense. However, it is helpful to see current practicing NDs directly endorsing such nonsense.
If there is going to be a public debate about whether or not NDs should be licensed, then let’s have the debate be public.