Earlier this year, a new review paper was published claiming to show evidence that naturopathy was effective (Myers et al. 2019). I’m a bit late to the game on this one, but I still want to briefly talk about this review, because it is a good illustration of the deceptive tactics people often use to claim that quack treatments are effective.
The paper in question is, “The state of the evidence for whole-system, multi-modality naturopathic medicine: a systematic scoping review.” The first thing to note is that it was published in The Journal of Alternative and Complementary Medicine. It is hardly surprising that a journal dedicated to alternative medicine is going to publish a paper claiming that alternative medicine works. In other words, this review was not published in a respected medical journal. Rather, it was published in a biased journal with a reputation for research that is questionable at best. This is a big red flag.
Nevertheless, let’s look at how they set up the review, but before getting to the review itself, I want to use an analogy that will help to illustrate the issues with it and with naturopathy more generally. I’m a big fan of analogies because they help to reveal underlying problems in reasoning.
So, for this analogy, let’s imagine that I have started a new type of medicine called electroism, in which I argue that electrical imbalances in your body are the cause for most diseases, and to cure these issues, you need to eat healthy, exercise, and periodically electrocute yourself with a 12-volt battery. Now, imagine that multiple studies look at the effects of electrocuting yourself with a car battery and conclude that it is not a good idea. I then respond by saying that those studies are invalid because you can’t look at just one piece of electroism in isolation. You have to look at the whole system together, and when you do that, electroism is beneficial.
Do you see the problem? Do you see how I have deceptively manipulated things to make it look like electroism works? My ridiculous electroism method includes both utter nonsense (electrocuting yourself) and things that are known to cause improvements and are fully embraced by the medical community (i.e., diet and exercise). Thus, by insisting that electroism can only be studied as a whole, I can make it look like electroism is beneficial, because I’ve now included things that do work alongside my nonsense. In other words, if you make a Venn diagram of actual medicine and electroism, there will be a zone of overlap containing diet and exercise, and by insisting that electroism has to be taken as a whole, I can deceptively use the benefits from that zone of overlap as evidence that electroism as a whole works.
My example may seem silly, but that is precisely what naturopathy does and what this study did. You see, naturopathy is very broad and involves a few good things and a whole lot of nonsense, but naturopaths (and the study authors) insist that it has to be looked at as a whole. As a result, the benefits of the good parts (which are also in actual medicine) make the nonsense parts look good.
Let me explain that in more detail. As the study states, “The [World Naturopathic Federation] defines the naturopathic profession based on two fundamental philosophies of medicine (vitalism and holism).” Holism is a semi-scientific concept (depending on how it is applied). It is the notion that we should treat the whole person and consider factors such as mental health and socioeconomics when treating someone. In some cases, this is fine, and is often a part of mainstream medicine. Stress and other lifestyle factors can lead to medical issues and I have no inherent problem with taking those into account during medical diagnoses. This is admittedly an anecdote, but I once went to a doctor (a real doctor) with digestive issues, and after running some tests and talking to me, she determined that I was probably just stressed to the point of making myself physically sick (she was right). This does not, however, mean that all medical issues are being influenced by multiple factors. Sometimes an infection is just an infection, which is where holism starts to get into trouble.
Vitalism is far more problematic. This is the notion that living things are somehow fundamentally different from non-living things and living things have a vital life force which can affect health. This is where all manner of “energy” based treatments start to come into play, and the whole thing is pre-scientific hogwash. There is no evidence or logical reason to believe that there is some mystic energy or force that affects your health and can become out of balance. That’s nonsense, not science, but by coupling that nonsense with science, naturopaths came make it look like they are onto something (just as I did with electroism).
So, what do naturopathic treatments actually involve? Well, quite a few things. There is generally a large focus on eating better, exercising more, and making lifestyle changes. Again, this is all well and good, and actual doctors would have no problem with that. If you go to a real doctor with high blood pressure, you will likely get medication, but you’ll also almost certainly be told to eat healthier and exercise more.
Other treatments are more problematic. They include things like homeopathy. I’ve written about homeopathy before, but in short, it is based on three fundamental principles, all of which are ridiculous. First, it argues that “like cures like.” This means that something that causes a set of symptoms in a healthy person will cure an ailment that causes the same symptoms. For example, some homeopathic sleep aids use caffeine as the active ingredient, because caffeine causes the symptom of sleeplessness in a healthy person (see why I said this was ridiculous?). Not to worry though, homeopaths “solve” this by invoking their second principle: dilution. According to homeopathy, diluting something will make the beneficial properties stronger while removing the harmful properties. If that sounded like utter nonsense, that’s because it was. That’s clearly not how dilutions work. Further, homeopathic remedies are often literally so dilute that not a single molecule of the active ingredient remains. In other words, they are literally just water. This is where the third principle comes in. According to homeopathy, water has memory, but somehow it only remembers the beneficial properties of the long-gone active ingredient while forgetting all of the poo, dirt, and other things it has come into contact with. Homeopathy is utterly absurd. It is hokum that is completely at odds with science, reality, and common sense, yet it is often a part of naturopathy.
Naturopathy also often includes various components of “traditional Chinese medicine” such as acupuncture (though this particular review excluded TCM). I’ve written about acupuncture at length before, but briefly, there is no known mechanism, accupoints don’t actually exist, and studies on it have found very inconsistent results, with even the positive studies reporting only extremely slight improvements. This strongly suggests that it is just a placebo.
Another core “principle of practice” in naturopathy is the “healing power of nature.” In other words, naturopathy (as its name suggests) is built on the notion that “natural” treatments are automatically better than “artificial” ones. This is not a scientific concept. In fact, it is a logical fallacy known as an appeal to nature. The fact that something is natural tells you absolutely nothing about whether or not it is safe and beneficial. Nature is not a kind entity that is looking out for your vest interests, Cyanide is, after all, natural. Nevertheless, naturopaths use this principle as the justification for prescribing all manner of herbs, supplements, and other “natural remedies.” The science behind these varies, but as a general rule, they either haven’t been tested or have failed testing, otherwise, they would be a part of mainstream medicine (e.g., Aspirin).
There are countless other quack remedies used by naturopaths, but I digress. I realize that this all seemed like a very round about way to introduce the study, but it was important groundwork for what the authors did. You see, when things like homeopathy, acupuncture, and most herbal remedies undergo proper, controlled scientific testing, they tend to fail those tests. To solve this, naturopaths (and the authors of this study) argue that we have to look at naturopathy as a whole, rather than studying the particular methods it uses. So, the authors ignored all of the studies looking at individual components of naturopathy and only included studies that included multiple “modalities” (treatments), the vast majority of which included diet and exercise as some of the treatments!
I want you to note that this is exactly the flawed reasoning that I used to support electroism in my example, and it fails for all the same reasons. Which actually makes more sense, that homeopathy only works when coupled with diet and exercise or that diet and exercise work and homeopathy is pseudoscientific bunk that was just along for the ride? This review guaranteed that naturopathy would look effective by using studies where evidence-based practices (diet and exercise) were included alongside nonsense (just as I could do, in my hypothetical example, by only looking at studies that included diet and exercise alongside a jolt from a battery).
Indeed, when you look at the studies in this review, you have things like a study that took patients with blood pressure problems and prescribed them better diets, more exercise, and herbs/supplements. Then, like a miracle, the patients’ blood pressure improved. Does that mean that the herbs/supplements worked? Of course not! The supplements are completely confounded by the diet and exercise, which we know work! In other words, because most of the tests included diet and exercise, they were totally confounded and do not let us draw any firm conclusions about the individual aspects of the treatments. All of the benefits could be entirely from the improved diet and exercise. At best, all that this review actually does is reaffirm that diet and exercise are beneficial. No shit, Sherlock.
Just in case my point here isn’t clear, let me try a different example. Good tires are known to improve your car’s fuel mileage. Now, imagine that someone tries to sell you a magic air freshener which will re-vitalize your car and balance its energy, but they tell you that it only works if you also install better tires. That person would obviously be a charlatan, right? The air freshener is irrelevant to the improvements in your car, and if it actually could improve your car, then it should be able to provide at least small improvements on its own. The same is true of naturopathy.
Finally, you may be thinking, “who cares if some of it is bunk if the net effect is improvement?” Responding to this is a whole post in itself, so I will simply say that the rational response is to increase the good parts of naturopathy in actual medicine (i.e., diet, exercise, good doctor-patient relationships) and discard the junk, rather than continuing to fund and perpetuate nonsense. This is especially important since, in many cases, people seek naturopathic remedies instead of actual medical treatment.
My point in all of this is simple. This study, and proponents of naturopathy in general, use the deceptive tactic of combing utter nonsense with exercise and diet, then pointing to improvements as evidence that the utter nonsense works. This strategy is both logically and scientifically flawed. These tests are completely confounded and, therefore, scientifically invalid. To see if things like supplements and homeopathy work, we have to eliminate confounding factors, and when we do that, they generally fail.
Note: there were multiple other problems with the review and the studies it cited, which you can read about at Science-Based Medicine.
- Acupuncture is just a placebo
- Debunking “The doctors case for homeopathy” by WDDTY: A case study in critically evaluating internet articles
- Homeopathic beer: a simple test of homeopathy’s absurd claims
- Is it likely that alternative medicine works? The importance of prior probability
- It’s just water: how homeopathy debunks itself
- Replacing science-based cancer treatments with “alternative treatments” increases your risk of dying from cancer (new study)