George Papanicolaou, who originated the cervical dysplasia test that bears his name (the Pap smear)
Naturopath Kate Whimster has written a case study of a patient with cervical dysplasia who was allegedly treated successfully with naturopathic treatment. She says:
In many cases conventional treatment can be invasive, ineffective, or can put patients at risk for future complications. Fortunately, there are wonderful naturopathic treatment options available both instead of or in conjunction with conventional medical treatments. This case study is a great example of naturopathic treatment for cervical dysplasia as part of my HPV Healing program.
The Patient
The patient was a 32-year-old woman who first had an abnormal Pap smear at the age of 26. Here is Whimster’s report of the course of events:
- February 2012: Pap HSIL, Colposcopy CIN I, Biopsy HSIL
- April 2012: LEEP procedure
- July 2012: Pap HSIL, Colposcopy CIN I, Biopsy HSIL
- August 2012: Start of naturopathic treatment
- Nov 2012: Pap LSIL, Colposcopy normal
- May 2013: Pap LSIL, Colposcopy CIN I, Biopsy LSIL
- July 2013: Pap ASCUS, Colposcopy normal, Biopsy normal
- October 2013: Pap normal, Colposcopy “cannot rule out CIN I,” Biopsy normal
- May 2014: Pap, Colposcopy and Biopsy all normal.
She was also successfully treated for a bacterial vaginal infection.
What do all those words mean? A primer on cervical dysplasia
Definition: Cervical dysplasia refers to abnormal changes in the cells on the surface of the uterine cervix, changes that can sometimes progress to cervical cancer.
Risk factors: Most cases are caused by infection with HPV (human papilloma virus). Risk factors include having sex before age 18, having a baby before age 16, multiple sex partners, illnesses or medicines that suppress the immune system, and smoking.
Pap smears: Specimens of surface cells are scraped from the cervix during a pelvic exam and are examined under a microscope. Findings are reported as:
- AGUS: Atypical glandular cells of undetermined significance. Rare, less than 1% of Pap results; can indicate conditions other than cervical dysplasia.
- ASCUS: Atypical squamous cells of undetermined significance. Most common abnormal result; very mild changes that could be due to infection, inflammation, or precancerous changes. Not considered cervical dysplasia unless confirmed by further testing.
- LSIL: Low grade squamous intraepithelial lesion. Mild dysplasia, likely caused by HPV. In most cases, clears up on its own within two years.
- HSIL: High grade squamous intraepithelial lesion. Could lead to cancer.
- Possibly cancerous but must be confirmed by biopsy.
Biopsy: A piece of tissue is cut out and examined by a pathologist.
- Colposcopy: An office procedure. A microscope and stains are used to find suspicious areas to biopsy.
- Cone biopsy: A hospital procedure. Removes a cone-shaped chunk of tissue from around the entire circumference of the cervical opening.
- LEEP excision: Loop electrosurgical excision procedure. An outpatient biopsy where a tissue sample is excised with a low-voltage electrical wire.
CIN: Dysplasia seen on biopsy specimens is classified as cervical intraepithelial neoplasia.
- CIN I: mild dysplasia.
- CIN II: moderate to marked dysplasia.
- CIN III: severe dysplasia to carcinoma in situ (early cancer).
Keep in mind that Pap smear and biopsy findings depend on the interpretation of a pathologist looking at slides under a microscope. These are not clear-cut yes-or-no diagnoses; there is a subjective element, and the classifications gradually shade into one another on a spectrum, so pathologists may not always agree with each other.
Treatment: LSIL and CIN I may go away without treatment. Doctors may decide to simply follow the patient with periodic Pap smears. Moderate-to-severe dysplasia or persistent mild dysplasia can be treated by various methods. Cone biopsy or LEEP excision may entirely remove the abnormal tissue. Lasers, cryotherapy, and hysterectomy are other options.
Naturopathic treatment
This naturopath used a combination of 5 treatment modalities:
- Nutritional treatment consisting of both diet and supplement recommendations focused on female hormone balance and supporting the immune system in resolving viral infection. Specific nutrients included beta carotene, vitamin C, vitamin E, folic acid, zinc, and green tea extract at therapeutic doses for 3 months and then more moderate doses for 12 months.
- Botanical treatment consisting of a custom compounded herbal tincture focused on immune support and specific anti-viral activity for 3 months.
- Vaginal suppositories focused on resolving viral infection and healing cervical tissue for 12 weeks.
- Biotherapeutic drainage to improve female hormone balance and support healthy elimination and immune function.
- Homeopathic treatment to address patient’s overall state and promote healing.
On her website, she describes her HPV Healing program. She reviews past and current lab results to determine the best treatment for the individual, and if necessary she will perform a “naturopathic gynecological exam” including a Pap test. She answers the question “How does it work?” but does not ask the question “Does it work?”
Are these naturopathic treatments supported by evidence?
While it is a truism that maintaining a good state of health helps the body fight disease, these naturopathic treatments have not been tested, and there is no evidence that any of them improve the outcome in cervical dysplasia. There is good evidence that highly dilute homeopathic medicine is nothing but water: it not only doesn’t work but it can’t possibly work given our current knowledge of physics, chemistry, and biology.
Who is this naturopath?
“Dr. Kate” is a graduate of the Canadian College of Naturopathic Medicine. She developed an interest in naturopathy while she was studying economics. She “got fed up with feeling bloated, cranky, and tired” and she allegedly cured herself with D’Adamo’s unscientific Blood Type Diet. She practices in Toronto and has a website that promotes homeopathy and other questionable treatments. She offers whole body detox. She advises against birth control pills because she thinks they “obscure your true state of health,” and she recommends less reliable methods of contraception (the rhythm method and condoms).
She is treating cervical dysplasia without even mentioning the HPV vaccine, the most effective thing that can be done to prevent cervical cancer. Nowhere on her website does she address vaccines except to say that we should consider their “implications” for immune health. She says “kids need to get sick” to educate their immune systems. I suspect she is anti-vaccine or at least not pro-vaccine. Studies have shown that the patients of naturopaths are less likely to be immunized.
Jann Bellamy has written about what other naturopaths have recommended for cervical dysplasia, and their advice doesn’t align with what Dr. Kate recommends. None of their recommendations are evidence-based and nowhere do they even mention HPV vaccines. That’s probably one of the things that makes practicing naturopathy attractive: instead of following evidence-based consensus guidelines, you have the freedom to improvise and make things up as you go along.
What really happened here?
This patient’s cervical dysplasia resolved over time, as expected. The American College of Obstetricians and Gynecologists have pointed out that CIN I is most often due to a transient HPV infection that will usually clear in a year and does not require treatment in average-risk women.
This patient was appropriately treated and followed by her gynecologist. There is no reason to think the addition of naturopathic treatment affected the outcome. Whimster’s case study is a good example of the post hoc ergo propter hoc fallacy: she assumes that because the patient got better with naturopathic treatment, she got better because of naturopathic treatment. Assumptions like this from case studies are often false; they must be tested in controlled scientific studies before they can be accepted as true.
This naturopath has a different concept of “evidence” than we do on SBM. It is obvious from her website that she endorses a number of ideas that are not based on credible scientific evidence. It is easy to see how experiences like this case study and like her experience with the Blood Type Diet serve to bolster her confidence in what she is doing. Confirmation bias is at work here; she doesn’t seek out any information that might disconfirm her beliefs.
Conclusion
There is every reason to think this patient improved in spite of her naturopathic treatment, not because of it. There is no reason to think naturopathic treatment is a useful addition to the mainstream treatment of cervical dysplasia or could substitute for conventional treatment. Most of Whimster’s treatments probably do no harm, and in this case the naturopathic treatments were used along with conventional treatment, but her website suggests that she is using naturopathic treatments instead of conventional treatments in some cases. Some of her advice could be dangerous.