A recent editorial in Healthing.com argues: “In a time when many Canadians don’t have access to a medical doctor, naturopathic doctors can help fill the void and ensure that the cycle of care remains intact.” The article, however, fails to give proper context as to what naturopathy is, relies on anecdotal evidence and poor arguments, and is ultimately just an advertisement for dubious medical practices.

We have written extensively about naturopathy here at SBM. This includes an inside look at naturopathic training from a former naturopath, a series on how naturopathic claims clash with science, a look at a naturopath textbook, and more. The quick version is that naturopathy is a collection of practices that have in common only that they are mostly unscientific, that uses “natural” as a vague marketing term, and is poorly regulated with no discernable standard of care. While naturopaths might mix in some genuine advice, the bottom line is that anything that is uniquely naturopathic does not work, anything naturopaths do that works is not unique to their profession, and most of what they do is both not original and not scientific.

For example, a major part of naturopathic training and practice is homeopathy – a thoroughly discredited “magic potion” form of medicine. Any practitioner who espouses and uses homeopathy cannot also claim to be science-based.

But naturopaths are tireless in promoting their profession, seeking equivalency with medical doctors and more access to patients, insurance coverage, and prescribing privileges. One of their strategies has been to wedge themselves into what they perceive as cracks in the medical system. That is the basis of the current article – there is a gap in physician access in Canada, so perhaps naturopaths can fill that gap. That, of course, would be an absolute disaster for Canadian medicine and health consumers. Magic and nonsense cannot fill the gap of legitimate medical care.

As if often the case, the article starts with a heart-warming anecdote about a client who was given turkey tail mushroom (Coriolus versicolor) to help treat their “blood cancer”:

He suggested Carrie try the funny sounding fungus, which is said to be packed with antioxidants that enhance the immune system. After several weeks, he says, her blood work was so good that even her doctors were “blown away.”

There is a lot to unpack even in this short sentence. First, saying that antioxidants enhance the immune system is highly problematic. Immune function is notoriously complex and difficult to assess, therefore using markers of immune function can be highly misleading. Clinical outcomes in controlled studies are needed – and they consistently show that antioxidants are useless and potentially even harmful in many conditions. One reason is that oxygen free radicals are actually used by the immune system to kill invaders, and therefore antioxidants can impair immune function. But even in conditions caused by free radical excess, supplemental antioxidants don’t work, likely because they simply have very small impact (orders of magnitude less) than the naturally occurring antioxidants in the body.

But throwing out the term “antioxidants” is good marketing, because the public has been primed by two decades of misinformation about antioxidants based on outdated and simplistic hypotheses. That’s what naturopaths have to offer – bad science but good marketing.

Also, saying that her doctors were “blown away” by the blood work is pretty vague and lacks any medical detail. What other treatment were they getting, and how did their blood work compare to baseline and other patients in a similar situation? Even still, one snapshot of one patient is the very definition of anecdotal. But the author does also conclude with this:

As for Carrie’s use of turkey tail, her blood work today is not as good as it was six months ago, despite consistency with her diet and exercise. And while Downie acknowledges that he has heard from countless people about the benefits they have experienced taking the supplement, he also believes that it’s not the only thing that makes positive change happen. Also playing a role is the combination of different lifestyle and diet choices, as well as the fact that no one person experiences recovery the same way.

So the turkey tail did not appear, even in this anecdote, to have any effect after all. But that’s OK, the naturopath was happy to blame the patient for their “lifestyle and diet choices”. Absent from the article, strangely touting naturopathy as science based, was the actual science looking at turkey tail as adjunctive or supportive treatment for cancer. Here is a 2022 Cochrane review:

Due to the very low certainty of evidence, we were uncertain about the effect of adjunctive Coriolus (in the form of an extract PSK) on adverse events resulting from conventional chemotherapy for colorectal cancer. This includes effects on withdrawal of treatment due to adverse events and on specific adverse outcomes such as neutropenia and nausea. The uncertainty in the evidence also means that it was unclear whether any adverse events were due to the chemotherapy or to the extract itself. While there was low-certainty evidence of a small effect on overall survival at five years, the influence of reduced adverse effects on this could not be determined. In addition, chemotherapy regimens used in assessing this outcome do not reflect current preferred practice.

So the evidence was so low quality the authors could not make any recommendation, they could not rule out harm from the treatment, and in the studies patients were not getting current standard of care. This is the kind of low quality preliminary evidence we see for many dubious treatment, which rarely survive more rigorous study. This is hardly above the line for an evidence-based practitioner, but was chosen as the example of what naturopaths have to offer.

As further promotion the article quotes an ND:

“If someone is undergoing conventional cancer treatment, we’re there to support them by helping improve their quality-of-life symptoms,” says Dr. Mark Fontes, naturopathic doctor at Insight Naturopathic Clinic in Toronto and Chair of CAND. “[That includes] improving sleep and appetite, reducing muscle pain [through] dietary interventions, herbal medicine, targeted supplements, minerals and vitamins. “We’re highly trained in managing chronic disease, from inflammatory bowel disease, to Lyme disease, chronic pain, digestive and hormonal concerns.”

As we have extensively documented here, naturopaths are not adequately, let alone “highly”, trained in primary care or managing illness. What they offer that is legitimate, such as nutritional advice, symptom management, and sleep hygiene, is already part of standard medical care. What they add generally goes beyond the evidence and ranges from unnecessary to harmful.

Monitoring and carefully managing nutrition, for example, is part of standard care for cancer. But this has to be done in an evidence-based way. Supplementing inappropriately can actually cause harm because cancers are highly metabolically active, therefore some vitamins can actually feed the cancer and allow it to better-resist chemotherapy. Killing cancer cells while maintaining health in the patient is a delicate balance. Paying close attention to the best clinical evidence is critical, and that is not what naturopaths offer.

There is also evidence that patients who supplement their cancer treatment with alternative treatments, such as those offered by naturopaths, have worse clinical outcomes. This evidence is pretty clear for those who start with alternative medicine, which is what would be the case if naturopaths were indeed filling the gap as primary practitioners. But even for those who complement standard of care with alternative treatment, the evidence shows no benefit and perhaps slight harm. Further, the culture of alternative medicine is such that the risk of refusing effective treatment is higher in users, even if they start out just wanting complementary treatment.

Any reasonable assessment of naturopathy leads to some clear conclusions. Naturopaths are not qualified to function as primary care practitioners. Most of their practices are demonstrable pseudoscience, and at best they flirt with the limits of evidence-based medicine. What they offer is either redundant, or ranged from useless to harmful. And overall they foster a culture of antiscientific notions about health and medicine.

Author

  • Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.

Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.