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Naturopathy and evidentialism

This was originally posted on my training blog, for my clients, but I figured there is some overlap with ideas discussed in the atheist ‘activist‘ movement, so for fun, I thought I’d include this post here (it is also related to this post).

Nauropathy
Naturopathy is a growing business, much like the supplement industry in general. A client of mine told me she was going to go see a Naturopath to sort out her “energy levels” so I told her to wait, and let me order my thoughts, and collect some literature on the topic.

David Gorski over at Science-Based Medicine (I would highly recommend him when searching for someone who debunks “woo” and “quackery“) demonstrates some of the thinking on Naturopathy by real doctors and science minded people:

Naturopathy is a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease that fancies itself to be science-based.” (Gorski 2011)

Much in line with Gorski above, the sub-heading that Naturopathy falls into also shoots itself in the foot, “alternative medicine“, what does that mean exactly? Is it the alternative to the medicine that works? Seems to me if Naturopathic products did work, they’d simply be “medicine“, and they’d be prescribed by doctors. My general thoughts on Naturopathy are the same as those on supplements in general, while I don’t want to fall into the habit of making absolute statements, there is much money spent on the advertising and promotion of supplements, including those pushed by the “Natural” crowd, but not much science, hence very little validity in the products, as a whole.

Naturopathy’s basic philosophy and advertising seems to be based on the naturalistic fallacy, as in what is natural is good for you. Opium is natural, marijuana is natural, poison berries are natural, yet I’m not sure there would be much argument stating those things are good for us, in the simple health sense (our right to partake in them however is a different discussion) of the word. So I don’t lend much credence to the status of the advertising used by Naturopaths, how can you when the basis for such is fallacy? As Orac says on his blog, Respectful Insolence:

Normally, naturopathy and other forms of “alternative medicine” are associated with large population centers full of people who, because they live in large population centers yearn for the natural and earnestly believe that, just because it’s natural it must be better.” (Orac 2011)

Nauropathy and Evidentialism
This gets back to standards of evidence, our basis for discerning what we should believe. As discussed briefly here, I support an evidentialist approach, particularly for science based enterprises as our review of Naturopathy should be. Does it work? Is it cost effective? How do we know if it works? Things of this nature. Unfortunately I don’t accept anecdotal evidence on this subject, self reporting, self diagnosing, if Naturopathy and it’s products don’t have evidential support in the literature, from reliable sources, with appropriate methodology, then how can we have a solid basis for trusting it? As philosopher William K. Clifford is quoted in Michael Martin’s book The Case Against Christianity:

it is wrong always, everywhere, and for anyone, to believe in anything on insufficient evidence.” (Martin Pg-19, 1991)

And as mentioned, though I don’t want to get into the habit of making or supporting absolutist statements, as a general heuristic, this rings true for me, as Martin continues and justifies:

Clifford maintains that believing on insufficient evidence has a variety of harmful consequences. It corrupts our character, undermines public confidence, leads to irresponsible action and fosters self deception.” (Martin Pg-19, 1991)

All of which I would agree with and can specifically be applied to Naturopathy. This demonstrates why we must base our selection of every and all Naturopathic products on the literature, on sound methodology, and scientific sources, not on the advice of the person behind the counter at the Naturopathic clinic, with an agenda (to sell you products).

I did research reviews of Pub Med here, and here, and could only find anecdotal reports and psychological benefits (akin to calling the products placebos). When these products cost as much as they do, sometimes used in conjunction with other products, we start to get into a cost/benefit analysis, for products I might add, with perhaps little to no evidential support. There might be some merit for the placebo affect by itself, but this runs the risk of giving patients placebos when they might need actual medication to help with a treatable yet dangerous disorder.

Are we just spending our money on expensive products that make us feel better emotionally, and in some cases avoiding proper medical treatment in favour of these products? Is this a positive? Does the psychological benefit outweigh the negative health consequences? Would we not be better off spending money on making traditional, effective treatments appear psychologically appealing to people? Is there a bias against medical science because it’s not a perfect science? David Gorski over at Science-Based Medicine seems to agree that there is almost an anti science based medicine bias, or at least an inability to discern truth (which would be aided by using the literature as opposed to self reporting):

It turns out that science and science-based medicine are hard for humans to accept because they often conflict with what our senses perceive and brains interpret as irrefutable evidence. The pattern-seeking function of our brain, when evaluating questions of causation in medicine, frequently betrays us…. Similarly, believers in “alternative medicine” who experience improvement in their symptoms also pour derision on the observation… people frequently take remedies when their symptoms are at their worst, leading them to attribute natural regression to the mean to whatever nostrum they started taking at the time.” (Gorski 2011)

This gives us a basis for the popularity of Naturopathy, in the sense that, we as humans are bad computational machines, who see the world through our biases, this is why an evidentialist approach is so important. It gives us an objective (as much as that is possible)  standard to weigh our biases against. Often Naturopathic products are trotted out as a safe alternative to medicines, to anti biotics, to which I ask: “does an imperfect product, that yields demonstrable results, such as modern medicine validate a product with no evidential support, or demonstrable results, such as much of Naturopathy?” I would say obviously, and demonstarbly not.  Which leads us back into Martin, who raises an interesting point:

However, Clifford was talking primarily about believing something on insufficient evidence, not about believing something that is contrary to the evidence.” (Martin Pg-19, 1991)

I think that is an important point to emphasize, not only do we accept Naturopathic products based on a misunderstanding or on limited to no evidential support, sometimes we accept them in the face of contradictory evidence, which is all the more damning. As Martin continues:

If there is anything to Clifford’s utilitarian arguments when…. doctrines are based on insufficient evidence, there is even more to them when belief in such doctrines goes against the evidence. (emphasis added) Although believing in… doctrines that are in conflict with the evidence is not necessarily morally wrong… there are certainly moral dangers in doing so, and as a general social policy believing something that is in conflict with the evidence should be avoided.” (Martin Pg-19, 1991)

The central theme here is in regards to evidentialism, and why as a basic foundational standard it is important. If we are not basing our Naturopathic choices on the evidence, then we are on shaky ground, if we base them on information counter to the literature, we are on dangerous ground, a ship at sea with no rudder. After all, how can we be sure of the efficacy of anything in this instance if we don’t base it on an objective standard? Are we to take the word of the person selling us something? Are we to take it based on how we “feel” when we take a Naturopathic product? If this is our standard and we wanted to be consistent, think of all the things you would have to buy or ingest.

Evidence for Naturopathy?
There are Natural “journal” sources out there, such as the Natural standard, but as Gorski demonstartes here:

Let’s just put it this way. Dr. Ulbricht has published at least one review of homeopathic remedies, specifically Oscillococcinum, in which she concludes that it probably works and that more studies are needed.” (Gorski 2011)

Gorski demonstrates what I discuss above, even when studies are done directly on Naturopathic remedies and are done so by institutes that promote them, they can’t get results, they can’t get a reproducible standard to promote. Only an assurance that it “probably works“, is this convincing I ask?

Conclusion
With all that in mind, I guess I should say, and it should be obvious from my blog and this post, I’m for an evidence based approach. If a particular supplement, Naturopathic or bodybuilder has evidential support, I’m going to support it too, as I do with fish oil, creatine, protein, and probiotics. The problem is, most supplements, for either the bodybuilding or Naturopathic communties, don’t have evidential support. I hope I’ve demonstarted why we should base, even just our scientific decisions, on evidence.

I’ve really only shown why evidence is important when making decisions in this particular blog, as a basic heuristic to all my clients and readers who want to try Naturopathic products, I would suggest: research them, in the literature. Search medical journals, science minded individuals, skeptics, get the best picture of what you’re buying, and what you’re putting into your body, because what you do may not just be a colossal waist of money, but could be dangerous to you.

To my clients such as the above and others who are looking to increase their “energy levels“, I would say, make sure your diet is in order, make sure you’re getting enough calories, water,  fruit and vegetables. Real, whole, organic foods are going to provide much of what you need, if you have an ailment, see a doctor, if you feel rundown; exercise, and eat properly. Expensive and untested supplements should not be on your radar.

References
Gorski, D., (2011). Dr. Oz on alternative medicine: Bread and circuses. Science-Based Medcicine. Retrieved 27/06/11. http://www.sciencebasedmedicine.org/index.php/when-oz-met-novella/

Gorski, D., (2011).  Motivated reasoning, Alternative medicine, and the anti-vaccine movement. Science-Based Medcicine. Retrieved 27/06/11. http://www.sciencebasedmedicine.org/index.php/disgraced-and-discredited-gastroenterologist-andrew-wakefied-nelson-mandela-and-jesus-christ-rolled-up-into-one/

Martin M., (1991). The Case Against Christianity. Philadelphia. Temple University Press. Pg- 19.

Orac., (2011). Naturopathy invades the heartland. Science blogs: Respectful Insolence. Retrieved 23/06/11. http://scienceblogs.com/insolence/2011/05/naturopathy_invades_the_heartland.php?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+scienceblogs%2Finsolence+%28Respectful+Insolence%29&utm_content=Google+Reader

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