Friday, May 3, 2013

Naturopathy, a CMAJ Study, and Junk-Vagueness Galore

here, I muse upon a recent study by naturopaths published in the Canadian Medical Association Journal.  First, I critique the title and look at the authors [see 001., below]; then, I look at what is being touted in the study 'as naturopathy' as compared to 'what critics say naturopathy compositely is' [see 002., below]; finally, I wonder what's happening to standards [see 003., below]:

001. the title and authors of CMAJ's "Naturopathic Medicine for the Prevention of Cardiovascular Disease: A Randomized Clinical Trial" [accessed 2013-04-30; the study is 'subject to revision' -- whatever that means]:

001.a. the title:

and the word games begin, wherein this sweeping vagueness called "naturopathic medicine" is posed as something specific [as in specifically studied here]!  Imagine if the title was, more appropriately, 'Things for the Prevention of Cardiovascular Disease: A Randomized Clinical Trial.'  That's how useful I think the term "naturopathic medicine" is in this title!  It has no operational definition and is equivalent to saying "things."  The big question is 'what things'?  What specifically was done MUST be in the title or else this is just a violation of parsimony, whereby mundane lifestyle interventions that exist already outside of naturopathy that naturopathy has subsumed as 'essentially naturopathic' all of a sudden magically support this sweeping vagueness called "naturopathic medicine."  E.g.: just because a scientifically rigorous study supports the inclusion of a minimum amount of vitamin C to prevent scurvy ONLY supports that-thing-itself.  If we titled that vitamin C study "Naturopathic Medicine Prevents Scurvy" we've violated parsimony, as we have expanded beyond what the data specifically are all about.  So I call FOUL on the title of this study.  It's the bad language of hack marketing hype and not the rigorous language of professional science.

001.b. 'who and where from are thou?':

001.b1. the eleven NDs [how many NDs does it take to screw in a light bulb?  Less than to author a study, I'll guess; so, I sense a certain kind of CV-dogpiling going on here!]:

"Dugald Seely ND MSc":

Seely, D. (ND CCNM), the PI, has a bio. up at AANMC wherein we're told of his CCNM ND, and that he also has a masters in science from UT.  CCNM claims naturopathy is science while being based on the science-exterior.  Also, AANMC that tells us that naturopathy is science while being based on the similarly science-ejected.  That collision of claims is a fact, and I've build up those databases over more than ten years.  The illogical of the whole thing I've termed 'the naturopathillogical'.  Here is ND Seely promoting naturopathic oncology on Youtube [vsc 2013-05-01] as "the Founder and Executive Director of the Ottawa Integrative Cancer Center" and he tells us in the video "we're about providing complementary and integrative care not about an alternative kind of care [...] there's a lot of questions, there's a lot of misunderstandings about the kind of options that are out there [...] some hype as well [...] we're trying to provide education and empowerment to people with cancer or survivors [...]  giving them the tools to better understand [...] there's many different choices for people who do have cancer."  Hmmm: since nonscience is posed as science institutionally by naturopathic colleges and universities, I'm not sure how an ND can 'educate and empower' and cut through hype about something as serious as cancer.  Here's a microcosm of the whole thing: CCNM hyping and misinforming about naturopathy's homeopathy [vsc 2013-05-01], stating: "'What Is Homeopathy?' will explain how homeopathic medicine can be used to treat a wide array of complaints [bull...] naturopathic doctors (NDs) are primary healthcare practitioners. The Canadian College of Naturopathic Medicine educates, develops and trains naturopathic doctors through excellence in health education, clinical services and research that integrate mind, body and spirit.  Interns at CCNM's Robert Schad Naturopathic Clinic improve their patients' health by identifying and treating the underlying causes of illness, integrating acupuncture/Asian medicine, botanical medicine, nutrition, homeopathic medicine, hydrotherapy/massage and lifestyle counseling."  Homeopathy is known, scientifically, to be bunk.  So, CCNM miseducates, and that bad education is what NDs will use as PHPs.  And it is called "excellence", because naturopathy is truly the reversal of all values, wherein, obviously, even the supernatural is posed as scientific!

"Orest Szczurko ND MSc"

Szczurko, O. (ND CCNM), who tells us in "Frequently Asked Questions About Naturopathic Medicine" [vsc 2013-05-01]: "what treatments do NDs use? [...] acupuncture and Oriental medicine: based on balancing the flow of chi (energy) through meridian pathways [...and] homeopathic medicine: based on the principle of 'like cures like' homeopathic medicine was developed in the 1700s. Minute amounts of natural substances are used to stimulate the body's self-healing abilities [coded vitalism]."  Yet, such prescientific ideas as chi are obviously not science, because vitalism is science-ejected, and energy is not an invisible immeasurable mystical thing in science.  Also, those meridians are truly without an ounce of scientific basis as is homeopathy.  Yet, overarching all of this, is his claim in "About Our Naturopathic Doctor" [vsc 2013-05-01]: "Dr Orest's focus is on helping his patients identify and address the underlying cause of their health problems by using the most current scientific evidence based patient focused naturopathic care."  And in "A Diagnosis of Cancer is Not a Death Sentence, It is a Call to Action!" [vsc 2013-05-01]: "as naturopathic doctors, we specialize in the scientifically informed integrative or complementary approach [...] a rigorously scientific approach [...] the naturopathic doctors at our Mississauga naturopathic health clinic are scientifically knowledgeable."  Science, science, science subset 'nonscience ideas and methods': same old naturopathic story.

"Kieran Cooley ND"

Cooley, K. (ND CCNM), also has an AANMC page, where we're told "Dr. Cooley is committed to fostering an evidence-based approach [EBM] to naturopathic medicine [...] an assistant professor at Canadian College of Naturopathic Medicine (CCNM) as well as the associate director of research."  But why oh why is naturopathy full of so much science-ejected junk like CCNM's homeopathy?  The sum of all evidence about homeopathy is that it is junk.  And of course, the EBM approach isn't enough, medicine must be SBM to be RIGOROUSLY scientific.  They talk of all this NEW applied research but refuse to do the research to establish naturopathy's basic premises: like the substantiation scientifically of CCNM's "prana or life force." A very selective use of inquiry, obviously.

"Heidi Fritz ND MA"
"Philip Rouchotas MSc ND"

Fritz, H. (ND CCNM) and Rouchotas, P. (ND CCNM), who practice together, state on their bio. page: "Heidi serves as a Research Fellow at the Canadian College of Naturopathic Medicine (CCNM), responsible for conducting studies of natural medicine for various health concerns, with a focus on cancer therapy [...] Heidi is certified in the use of intravenous vitamin therapies, including intravenous vitamin C, the modified Meyer’s cocktail, Iscador, Helixor, and others."  This sounds to me like human experimentation with disproven or implausible methods arising from wacko areas like anthroposophy and I cringe at the ethical implications.

"Serenity Aberdour ND"

 here's Aberdour, S. (ND CCNM) in the video "Staying Hydrated During Activity" talking supposedly about kids staying hydrated during sports yet ultimately promoting a certain line of sports drinks and supplements.  Start them young, I say!  The program couldn't find a better specifically qualified guest to speak on this like an exercise physiologist / physiology expert / pediatrician?  Anyway, she has written on the study.

"Craig Herrington ND"

Herrington, C. (ND BINM) is part of a practice that promotes homeopathy [vsc 2013-05-02] as effective. That web page also states "amongst the most effective naturopathic treatments for cancer, our naturopathic doctors are specially trained in high dose intravenous vitamin C therapy and mistletoe therapy", and chelation therapy is posed as an option for treatment of cardiovascular issues.

"Patricia Herman ND PhD"

Herman, P. (ND ?) does something very typical of NDs in that she codes naturopathy's science-ejected vitalistic central premise [vsc 2013-05-02] at her web page explaining naturopathy.

"David Lescheid ND PhD"

"Ryan Bradley ND MPH"

Bradley, R. (ND Bastyr). Bastyr is my favorite for the label upon naturopathy of "science based natural medicine", most recently adding into that fold the medieval Hindu medical practices known as ayurveda.  And again, why is homeopathy under that label if science-based?

"Tara Gignac ND"

Gignac, T. (ND CCNM).  Again, principles without a transparent context while this is the actual context.  And this: "the spirit / life-force."  Which you can also find at the naturopaths' organization [vsc 2013-05-02] in the same province as CCNM.

002. the study and what others say about it and naturopathy:

002.a. we're told by the authors:

"we performed a multisite randomized controlled trial of enhanced usual care (usual care plus biometric measurement; control) compared with enhanced usual care plus naturopathic care (hereafter called naturopathic care) [...] health promotion counseling, nutritional medicine or dietary supplementation [...] a multimodality nutritional and physical activity intervention in a workplace setting [...]";

I'm not particularly clear as to why such a cluster of interventions can be termed "controlled."  There simply seems to be too many variables to determine here what does and doesn't work, which is the antithesis to "control".  To me this is a game: use a confounded shotgun approach, include regular medical intervention and some added counseling and perhaps dubious nutritional pharmacy and call the whole thing naturopathic and successful without much specificity.

"we found a significant reduction in the risk of cardiovascular disease following counseling about nutritional and physical activity provided by naturopathic doctors [...] because a range of interventions were recommended to participants in the naturopathic group, the frequency and composition of each recommendation as well as participant adherence are not reported [...]"

 this smacks of an argument from authority as in 'trust us it works' but what works is kept behind a curtain.  Medical science without treatment operational definitions?  If I was getting the attention of two doctors instead of one, no matter how inert all the rest of the stuff, I too would likely be more motivated to change my such and such with the stuff they tout [some of which works, like EXERCISE!].

"because of the pragmatic design, this trial did not, nor could not effectively, blind trial participants or clinicians to allocation. As a result, the results are susceptible to expectation bias and potentially to measurement bias [..]";

ya think?  So, the study sucks in terms of rigor, and yet the word "controlled" was used.  I pose this as a better goal than what this study did: study 'the thing itself in a rigorous manner and maintain parsimony.'

002.b. what others have written [more qualified than me, for sure]:

[addendum 2013-05-13: also, David Gorski MD, PhD has applied his rapier expertise to this CMAJ study at Science Based Medicine. He's much much much more qualified than me, but agrees essentially with my central point that to label what was poorly studied as 'therefore naturopathic medicine and it works' is a ruse.]

002.b1. here's something Steve Novella wrote a while back at in "Blog Discussion with an SBM Critic" regarding pragmatic studies:

"we advocate for 'science'-based medicine, and not just 'evidence'-based medicine. Each type of evidence, in fact, is [can be] abused. We criticize the inappropriate extrapolation from basic science to clinical claims, assuming causation from observational correlation, failure to realize the limits of clinical trials, and the use of pragmatic studies as if they were evidence for efficacy."

002.b2. Colby Vorland "graduate student in a nutritional science program in the U.S."  writes in "Naturopathic Distraction" (2013-04-29):

"this morning I saw a press release that said 'Treatment By Naturopathic Doctors Shows Reduction in Cardiovascular Risk Factors' based on a Canadian study. The skeptical bells went off in my head as I read it: this sure seems like a study designed to legitimize naturopathy by focusing on non-controversial practices [...] this study was clearly designed to use non-controversial treatments to legitimize naturopathy [...] the standardized and limited treatments in this study do not reflect real naturopathic practice [...]";

hear, hear.

"the Canadian College of Naturopathic Medicine themselves say naturopathic medicine includes traditional Chinese medicine [...] homeopathy [etc....] as poignantly stated by Timothy Caulfield and Christen Rachul, with the exception of evidence-based nutrition and lifestyle changes these therapies do 'not support the proposition that naturopathic medicine is a science and evidence-based practice.' Their review of naturopathic practices in Canada found disturbing treatments such as colon cleansing, hair analysis, detoxification or biotherapeutic drainage [a form of homeopathy], IV therapies, chelation therapy and many others lacking scientific substantiation, and these are used to treat a wide variety of diseases. The basis of naturopathy is a mystical and unscientific belief in 'vitalism', and the practice has homeopathy at the core, which is literally using water to treat disease [...]";

nailed it!!!!!! 

"in an accompanying editorial, the journal’s (CMAJ) deputy editor, Matthew Stanbrook provides this warning ahead of inevitable naturopathic claims: 'we can learn nothing new from this trial about supplements or any other individual component of care, because the trial was not designed to allow their evaluation'.  Yet for some reason also writes: 'the results of Seely and colleagues provide proof of principle that some aspects of cardiovascular prevention could feasibly and effectively be delegated to naturopaths' [...]";

in other words, lets play with the readership and public and have it both ways: lets pose naturopathy as effective yet not actually know if that is true because that wasn't studied rigorously, lets benefit from the hype of all this and simultaneously warn the world about the expected misinterpretations and misrepresentations our study will bolster.

003. musing:

so, the junk-thought area known as naturopathy gets a lift from a rather major journal's publication of a very junky naturopathic study.  

and licensed falsehood marches on.

because standards do not exist or, at least, standard-bearers anymore.
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