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Naturopathy has been a recurrent topic on this blog. The reasons should be obvious. Although homeopathy is the one woo to rule them all in the U.K. and much of Europe, here in the U.S. homeopathy is not nearly as big a deal. Arguably, some flavor of naturopathy is the second most prevalent “alternative medical system” here, after chiropractic of course, and perhaps duking it out with traditional Chinese medicine, although naturopathy does embrace TCM as part of the armamentarium of dubious medical systems that it uses. In any case, some sixteen states and five Canadian provinces license naturopaths in some form, and in some states naturopaths are fighting for–and in some cases winning–the power to prescribe certain real pharmaceutical medications and order real medical tests. For instance, in California, naturopaths can order laboratory tests and X-rays, which reminds me of a conversation I had with a mammographer from California at TAM last summer. He told me a tale of the dilemma he had when naturopaths and other “alt-med” practitioners ordered tests at his facilities. Specifically, the dilemma came about because he doubted that the naturopath knew what to do with the results. Meanwhile, in Oregon, naturopaths can prescribe certain types of pharmaceutical drugs (as opposed to the usual supplements, herbs, or homeopathic remedies they normally prescribe). Meanwhile, moves are under way to expand the prescribing privileges of naturopaths in Canada, as Ontario (which is, remember, just across the Detroit River, less than two and a half miles as the crow flies from my cancer center—a truly frightening thought to me).

Unfortunately, naturopathy is a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. As a result, typical naturopaths are more than happy in essence to “pick one from column A and one from column B” when it comes to pseudoscience, mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine. Despite their affinity for non-science-based medical systems, naturopaths crave the imprimatur of science. As a result, they desperately try to represent what they do as being science-based, and they’ve even set up research institutes, much like the departments, divisions, and institutes devoted to “complementary and alternative medicine” ( CAM ) that have cropped up on the campuses of legitimate medical schools and academic medical centers like so many weeds poking through the cracks in the edifice of science-based medicine. Naturopaths also really, really don’t like it when they encounter criticism that their “discipline” is not science-based. Indeed, the president of the American Association of Naturopathic Physicians, Carl Hangee-Bauer, ND, LAc (he’s an acupuncturist, too!), wrote a revealing post on the official AANP blog entitled Science and Naturopathic Medicine.

Science. You keep using that word. I do not think it means what you think it means.

The President of the AANP takes umbrage

Apparently criticisms of naturopathy as unscientific have started to penetrate even the reality distortion field of the AANP, because Carl Hangee-Bauer has noticed them, and he’s not happy. Oh, no, he’s not happy at all. First, he begins by enumerating his bona fides as a science-loving geek, in order to prove to readers just how dedicated he is to science. These bona fides include a love of marine biology and a mention of how much he originally wanted to become a marine biologist. (Hey, I loved The Undersea World of Jacques Cousteau when I was a kid, too, you know.) Hangee-Bauer then discusses how he “took every course in biology, chemistry, physics, etc.” that he could in school and in college majored in biology, with dual minors in physics and chemistry. Then, somehow, while he was in the U.S. Army, he developed an interest in medicine as a Medical Service Corps officer, and that led him to naturopathy. Personally, this story leads me to ask: What happened to Hangee-Bauer? How could someone who was so interested in science go so far off the rails? Whatever happened, Hangee-Bauer’s narrative leads up to this lament about nasty bloggers like us:

I tell you this to let you know that I am no stranger to science. I still find it fascinating and appreciate the many ways it helps us understand the workings of nature and the world, helping us separate what appears to be the truth of things from reality. Studying naturopathic medicine, and especially acupuncture, presented me with many challenges, and I learned along the way that our medicine, as well as all other systems of medicine, are really a combination of science and art. When we work with our patients, we draw from both in order to stimulate the vis and provide well-rounded care to our patients. Thus it has become an increasing concern to me when I read articles and blogs on the Internet blasting naturopathic medicine for being “unscientific.” These frequently polemic articles, while professing to come from scientific logic, to my eye are biased misrepresentations of the truth. They often lambast our profession and philosophy as unscientific, yet I have yet to see any one of them provide a critical analysis of research done by naturopathic physicians and researchers. It is sad that science can be used in these political ways.

It’s very hard for me not to point out that in Hangee-Bauer’s case science has apparently not been particularly successful in helping him to separate “what appears to be the truth of things from reality.” He is, after all, an acupuncturist and naturopath. It’s also apparent from the website of Hangee-Bauer’s practice, which treats all manner of ailments, as listed here on this page. Out of curiosity, I started clicking around on the conditions for which Hangee-Bauer provided links. For example, naturopaths frequently claim to be able to treat allergies (whether you have them or not!); so I gravitated to the page on allergies first. After a description about how “allopathic” medicine treats allergies by blocking histamine, having the patient avoid the allergen, and desensitization, we then see this passage:

Let’s look briefly at an example of TCM treatment for allergies. John presented with acute allergy symptoms of one-month’s duration which included sneezing, runny nose with lots of watery phlegm, extreme fatigue and occasional loose stools. After taking his history and doing an examination, his acupuncturist assessed his condition according to TCM as Wei Qi Deficiency resulting from a weakness of the Lung and Spleen. In addition to general recommendations for his condition, John was given Minor Blue Dragon formula which has decongestant properties for those with copious clear phlegm, as well as Astra 8, an herbal formula designed to tonify the Lung and Spleen Qi. He was also told to minimize or avoid dairy products and excessively sweet or spicy foods. As John’s condition improved, he and his acupuncturist developed a plan to strengthen his immune system in preparation for next year’s allergy season. This plan included replacing coffee with green tea, which is rich in catechins which exert anti-allergy effects, as well as taking quercetin, a bioflavonoid which has been shown to stabilize mast cells thus slowing the release of histamine and other chemicals related to allergic symptoms.

One wonders what “science” supports the vitalistic prescientific notion that allergies are due to “Wei Qi Deficiency” or detonification of “Lung and Spleen Qi” requiring “tonifying” (whatever that is). In all fairness, however, I will give Hangee-Bauer credit for one thing: on the same page, he actually states that applied kinesiology “may be of no value in testing for an allergy.” Imagine my relief, except that he should have said “is of no value whatsoever” for diagnosing allergies. That relief is also tempered by Hangee-Bauer’s suggesting that “strengthening the immune system” in an allergy would be a good thing in preparation for next year’s allergy season. Given that allergies are due to an excessive histamine response to a particular kind of antigen, “strengthening the immune system” might well make it worse. Of course, “strengthening the immune system” is a meaningless phrase, as we’ve pointed out many times before, but apparently, for all his love of science, Hangee-Bauer hasn’t figured that out.

But let’s move on. Elsewhere on the web page, Hangee-Bauer’s practice recommends breast thermography as an adjunct to mammography. I was shocked. No, I wasn’t shocked that he recommended thermography, as thermography is very popular among the “alternative medicine” set. Rather I was shocked and relieved that Hangee-Bauer apparently still recommends mammography. Even so, his website parrots scientifically unsupported claims common among CAM practitioners that thermography can find cancer ten years before breast cancer is identified by other methods (claims of the sort that I wrote about recently), and that it should be done at least once a year to screen for breast cancer. Amusingly, there was then this claim:

Finally, licensed acupuncturists can use thermography to detect slight temperature variations which reflect disturbances in the flow of Qi and blood, which can result in pain and dysfunction. Concrete evidence that acupuncture therapy actually restores blood flow and normalizes disrupted temperature patterns has been proven by thermographic studies.

I would so love to see the scientific studies demonstrating that thermography can detect disturbances in the flow of qi and how acupuncture restores it and blood flow. Surely there must be such studies; Hangee-Bauer, after all, claims that he is all about science and just bristles with outrage at the commentary of bloggers who correctly castigate much of naturopathy for being unscientific. What he does is based on science, isn’t it? So show it! What is the science demonstrating that thermography can detect disturbances in the flow of qi?

These are but a couple of examples that stood out of unproven treatments modalities and scientifically–shall we say?–“debatable” statements that I found on Carl Hangee-Bauer’s web page. I encourage SBM readers to check out other examples, such as the pages on tips for lung health (complete with recommendations for regular acupuncture sessions to “increase your resistance to both viruses and allergens”), treating springtime allergies, naturopathic “detoxification” (it’s always about those evil “toxins,” isn’t it?), and, of course, treatment of heavy metal poisoning. You know, whenever I see the term “heavy metal poisoning,” I can’t help but think of Ozzy Osbourne being the way he is as a result of 40 years of heavy metal poisoning. Oh, wait. It was the alcohol and illicit drugs. And perhaps the heavy metal poisoning.

But I digress.

Perhaps the most bizarre bit of ostensibly “science-based” recommendations to be found on Hangee-Bauer’s website is something called biotherapeutic drainage. I must admit, I had never heard of biotherapeutic drainage before. It turns out that if you Google the term “biotherapeutic drainage,” you’ll find that naturopaths appear to love this particular treatment modality. But what is it? Erika Horowitz, one of Bangee-Bauer’s naturopath partners, describes it thusly:

Detoxification is a big part of naturopathic theory and practice.

I can’t help but interrupt right here and say: No kidding! Too bad these “toxins” are as fantastical as the “science” that naturopaths invoke to support “detoxification.” Horowitz then continues:

Helping the body eliminate toxins safely and effectively can play an important role in improving health and preventing disease. One of the most useful detoxification therapies I use in my practice is the use of UNDA numbers, which are unique combinations of liquid homeopathic formulas founded on the theories of Chinese medicine, homeopathy, and anthroposophy.

Wow. Apparently one woo isn’t enough; so Horowitz combines three. It’s hard for me not to imitate a commercial and say something like, “Biotherapeutic drainage. It’s three, three, three woos in one!” Oh, wait. I just did. In any case, I had never heard of UNDA numbers before, which means I’m definitely learning something while writing this post. Unfortunately what I’m learning is that, even though I’ve been at this several years now, I still haven’t learned all the forms of unscientific medicine and treatments that exist out there. I can still be surprised, and UNDA surprised me. Apparently, it’s this:

UNDA numbers consist of homeopathically prepared low-dose combinations of plants and minerals. The plants possess specific characteristics as to how they affect an organ or organ system; some may have a stimulating effect, whereas others will calm or sedate an organ’s functions. The minerals in the compounds affect how the cells carry out chemical reactions that are necessary to efficiently begin the detoxification process. So the plants guide the remedy to the appropriate organ system (be it digestive, cardiovascular, or respiratory) and the minerals help change the cells’ biochemical function. These remedies help the body detoxify by helping cells work more efficiently and eliminate waste effectively, and by improving how our organs of elimination work. UNDA numbers treat both acute ailments and chronic disease, addressing symptoms but more importantly concentrating on the reason that the body is manifesting the symptoms in the first place. The remedies are nontoxic, won’t interfere with other allopathic or holistic medications, and have a gentle yet deep-acting effect.

If they’re homeopathic, then I can’t really argue with two out of the three claims made for UNDA numbers. They certainly must be nontoxic and I’m sure they don’t interfere with other medications. Speaking of homeopathy…

One huge reason (among many) that naturopathy can’t be scientific

After this detour to Hangee-Bauer’s website, where we can find ample evidence suggesting that, when the rubber hits the road (or the patients hit the exam rooms) his dedication to science-based medicine is not nearly as strong as he proclaims in his message to the AANP, let’s move on to the single most glaring reason why naturopathy can’t be scientific. It begins when Hangee-Bauer lionizes Joseph Pizzorno, a prominent naturopath on the faculty at Bastyr University, arguably the most influential school of naturopathic medicine in North America, as having spent the past 25 years trying to use science to increase the credibility of naturopathy. Now I’ll give Pizzorno credit. For example, he did recognize as quackery Hulda Clark’s “parasite”-zapping “syncrometer,” which is a lot better than a lot of proponents of “natural medicine” have ever done.

On the other hand…

Pizzorno is currently the President Emeritus of Bastyr University, having been its founding President. Presumably he is still involved in Bastyr University, but until 2000 he was the one running its day-to-day operations right from the very beginning. Hangee-Bauer lauds Pizzorno as being a visionary in terms of trying to make naturopathy science-based, but there’s one problem with that view. Pizzorno’s school embraces homeopathy uncritically. It is, after all, a school of naturopathy, and there is are few forms of woo that naturopathy doesn’t embrace uncritically. Indeed, Bastyr not only embraces homeopathy, but requires its students to study it. Don’t believe me? Let’s start by looking at Bastyr University itself. Here is what the Bastyr University website says about homeopathy. First, it describes homeopathy as “natural” and “nontoxic” (the latter of which is hard to argue with, given that homeopathy is nothing more than water). It goes beyond that, though. Bastyr also offers homeopathy services in its clinics. As you may know, one of my favorite litmus tests for any CAM advocate’s connection with science and reality is how he reacts to homeopathy. If he embraces it, then I know that any protestations of being “science-based” are utter piffle. Bastyr University embraces homeopathy, just as naturopathy in general does.

More pertinent to the question of whether naturopathy embraces homeopathy is this answer to a question in Bastyr’s FAQ about homeopathy:

Q. Do all naturopathic physicians use homeopathy? A. All naturopathic physicians are trained in the use of homeopathy, but not every naturopathic physician will use it as part of their treatment.

Let’s repeat that: All naturopathic physicians are trained in the use of homeopathy.

All. Of. Them.

Consistent with the answer to this question on the Bastyr University FAQ, there’s a lot of homeopathy being taught and practiced at Bastyr. For example, if you look at its curriculum to become a doctor of naturopathic medicine, you’ll rapidly see that Bastyr requires a full year of homeopathy courses spread out over three classes for a total of 8 credit hours. The same is true for Bastyr’s five year track and its combined degree of Doctor of Naturopathic Medicine (ND)/Master of Science in Acupuncture (MSA) or Acupuncture and Oriental Medicine (MSAOM). In addition, Bastyr has a clinical homeopathy department and homeopathy teaching clinic. The department chair is a naturopath and homeopath named Richard Mann, ND.

But it’s not just Bastyr. Taking on Hangee-Bauer’s claims that the AANP is all about the science, let’s take a look at the AANP itself. If you take a look at the official AANP blog and search it for the word “homeopathy, you’ll rapidly see that the largest “professional” organization of naturopaths not only embraces homeopathy but defends it against attacks. Perhaps the best example of the attitude of the AANP towards homeopathy is found in this post from several months ago entitled Getting over it. In it, a naturopath named Christopher Johnson gets all indignant about recent “1023” campaigns that skeptics and proponents of science-based medicine have been using with some success to demonstrate the utter ridiculousness of homeopathy. (Indeed, one such event occurred recently, on February 5.) In response, Johnson writes:

They named their campaign “10:23”, a reference to Avogadro’s number. This number is significant to chemists in that it supposedly sets the limit below which no material elements are likely to be present in a given dilution. Homeopathic remedies are made with solutions far more dilute than Avogadro’s number. Do these “skeptics” really think the public cares about Avogadro’s number when homeopathy has just significantly improved their toddler’s autism or offered help with any of a vast range of diseases which respond so well to homeopathic (and often not to conventional) treatment? This is just another tantrum by the clueless wing of the scientific/medical community that can’t understand why the people don’t praise them for their ideological purity and courage, even when the fruits of their scientific labors rot like a brown banana. Note to protestors: maybe they’re just not that into you.

Remember, this is the official blog of the AANP—the organization of which Hangee-Bauer is the current president!—and it’s not just attacking, but rabidly attacking, a valid criticism of homeopathy. This valid criticism is nothing more than pointing out that most homeopathic remedies are diluted far, far more than Avogadro’s number, meaning that it’s highly unlikely (damned near impossible, actually) that a single molecule of the original starting material of the homeopathic remedy remains for dilutions of 12C or greater. When a typical homeopathic dilution is 30C (thirty 100-fold dilutions, or a 1060 dilution), that’s almost 1037-fold greater than Avogadro’s number. The magnitude of this dilution is simply incredible, and the odds against a single molecule remaining are just as incredible.

Particularly amusingly, Johnson likens these 1023 events to the persecution of Galileo in what is arguably one of the most hilariously over-the-top invocations of the “Galileo gambit” I’ve ever seen before. Behold:

These hooligans purport to stand up for scientific principles, while in fact their zealous dogmatism and denial of evidence would make Galileo’s persecutors proud. Score one for book burning and witch trials.

Because a little skeptical activism poking fun at the ridiculousness of the beliefs underlying the pseudoscience of homeopathy in such a way as to point out to nonscientists why it is pseudoscientific nonsense is exactly like putting Galileo under house arrest and burning books and witches. I am thankful for small favors in that Johnson restrained himself from comparing skeptics to Hitler or Nazis. Just barely. (Come on, Mr. Johnson, let it out. Play the Hitler/Nazi card! You know you really, really want to, and you’ll feel much better after you do.)

Science versus naturopathy

So far, all I’ve looked at is Bastyr University and the official blog of the AANP. In fact, though, every school of naturopathy whose curriculum I’ve ever examined includes homeopathy as a requirement, even as the AANP requires and defends homeopathy. It’s no wonder, too. There is actually a North American Board of Naturopathic Examiners, just like medicine’s National Board of Medical Examiners. The NABNE even has a certifying examination, just like real doctors! It’s all science-y and medicine-y, too, with all the trappings of science-based medicine but none of the rigor. This examination, the NPLEX (Naturopathic Physicians Licensing Examinations), which is required for naturopaths to be licensed in the sixteen states and five Canadian provinces that license naturopathic physicians tests naturopaths on homeopathy (emphasis mine):

The current examination, based on these original blueprints, forms the Core Clinical Science Examination now required by every state and province that regulates the practice of naturopathic medicine. The Core Clinical Science Examination is a case-based examination that covers the following topics: diagnosis physical, clinical, lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy , counseling, behavioral medicine, health psychology, emergency medicine, medical procedures, public health, pharmacology, and research. Two additional treatment examinations (Minor Surgery and Acupuncture) may also be required for eligibility to become licensed to practice as a naturopathic physician in some jurisdictions. […] The NPLEX Part II – Core Clinical Science Examination is designed to test your knowledge of: diagnosis (physical, clinical, and lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy , counseling, behavioral medicine, health psychology, medical procedures, emergency medicine, public health, pharmacology, and research. The examination is comprised of a series of clinical summaries followed by several questions pertaining to each patient’s case. For example, you might be asked to provide a differential diagnosis, to select appropriate lab tests, to prescribe therapies which safely address the patient’s condition, and to respond to acute care emergencies.

I would love to see what questions the NPLEX includes regarding homeopathy. My guess is that the multiple choice questions would be a hoot; that is, if I didn’t know they were completely serious. Unfortunately, as Kimball Atwood points out, no one other than naturopaths really knows what’s on the examination. Indeed, Dr. Atwood observed that naturopaths seem to take great pains not to let scientifically-minded physicians see a copy of an actual NPLEX examination. Be that as it may, homeopathy is but one example of how strongly naturopathy embraces pseudoscience. Be it myofascial analysis, vega testing, traditional Chinese medicine, Ayurveda, germ theory denialism, or even distant healing, there is no nonsense that naturopathy excludes as being too unscientific for it. Yet none of this stops Hangee-Bauer from bragging about how next year at the AANP Convention, it’ll be all about the science:

On August 16, 2011, the Tuesday before the start of the 2011 AANP Convention, the AANP will be sponsoring a scientific summit. While only in the early stages of planning, it promises to be a gathering for the different players in the naturopathic profession to connect and define how the AANP mission, naturopathic research, and evidence-informed health policy can join and result in healthier patients, a more effective health-care system, and a flourishing naturopathic profession. Core discussion points will include articulating policy and practice issues driving our research agenda, where the profession is now and what future possibilities exist, and defining the core research questions relating to safety, effectiveness, and costs.

You might recall that I wrote about last year’s AANP Convention, as did Dr. Atwood, both in the context of lamenting the appearance of Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine ( NCCAM ) as a speaker. You might also recall that last year’s AANP Convention was chock full of pseudoscience, including (of course) homeopathy, “medical intuitive” scans, emunctorology, “detoxification,” functional medicine, water-only fasting, and many others. If you click around the Naturopathic Physicians Research Institute (NPRI) website a bit (which Hangee-Bauer referenced in his post), you’ll find “research” about chelation therapy for autism and cardiovascular diseases (which is an utterly useless and potentially dangerous intervention) and homeopathy in pediatric care. I do have to thank Hangee-Bauer, however. I’ll keep my eye out for when the AANP announces its speaker list and agenda for its scientific conference on August 16 and the AANP Convention to follow immediately. I’m sure it’ll provide at least one good blog post in a few months.

In the meantime, if I may be so bold, I will make one small suggestion. If Hangee-Bauer is truly serious about making naturopathy science-based, there’s one thing he could do right away to prove it. It would be a simple, powerful, and unequivocal indication of the strength and sincerity of his intent. It’s all Hangee-Bauer has to do as a first step, albeit tiny, to demonstrate that he is not simply mouthing the words in praise of science and proclaiming how much he loves science and wants naturopathy to be based on science. All he has to do is to state that homeopathy is quackery, that it should no longer be considered part of naturopathy, and that he is going to put the weight of the AANP behind removing homeopathy as a required component of training in naturopathy and the examinations used to certify naturopaths. Extra points would be given for correctly stating why homeopathy is nothing but water and how there is no evidence supporting the law of similars as a general principle. If Hangee-Bauer does that, I might start to take his pontificating about the wonders of science and the scientific rigor of naturopathy somewhat seriously. If he can’t do it, then I know it’s a load of hot air.

After Hangee-Bauer deals adopts a science-based approach to homeopathy, then we can talk about purging distance healing, anthroposophy, applied kinesiology, and many of the other bits of pure pseudoscience embraced by naturopaths. However, like infants naturopaths have to creep before they can crawl and crawl before they can walk and walk before they can run. Eliminating homeopathy would be that first attempt at creeping. Does anyone want to lay any odds on whether or not the AANP will take that first creep forward?