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The deceptive rebranding of aspects of science-based medicine as “alternative” by naturopaths continues apace

That naturopathy is a veritable cornucopia of quackery mixed with the odd sensible, science-based suggestion here and there is not in doubt, at least not to supporters of science-based medicine (SBM). However, what naturopaths are very good at doing is representing their pseudoscience as somehow being scientific and thus on par with conventional SBM. So how do they accomplish this? Certainly, it’s not through the validation of any of the cornucopia of pseudoscience and quackery that naturopaths apply to their patients as though picking “one from column A and one from column B” from a proverbial Chinese menu of woo. Naturopaths’ favored modalities include homeopathy (which remains to this day an integral part of naturopathy that all naturopaths are taught), acupuncture and traditional Chinese medicine (TCM), “detoxification” practices (a key precept of a lot of naturopathy) such as juicing, enemas, and chelation therapy, and the various other quack modalities that make up the practice of naturopathy. Treatments like these (especially homeopathy, whose precepts would require a massive rewriting of the laws of physics and chemistry for it to work) have not been and almost certainly cannot ever be scientifically validated with an evidence base of the quality and quantity supporting SBM.

So, instead naturopaths play a very clever game. In all fairness, naturopaths are not the only practitioners of so-called “complementary and alternative medicine” (CAM) or “integrative medicine” who play this game, but from my observations they appear to be the most talented at it. Their skill at obfuscating the line between SBM and naturopathy is evidenced by the success they have had in state legislatures in expanding their scope of practice, most recently in Colorado, where, if there is not a groundswell of support urging the Governor to veto SB-215 (or, as Jann Bellamy aptly called it, the quack full employment act), consumer protections against quackery in Colorado will be laid waste. At the same time, there is a naturopath licensing act (HB-1111) sitting on the Governor’s desk as well that would license naturopaths and give them the path to mandatory reimbursement from insurance companies. Instructions to write to the Governor opposing both bills can be found here and here; they would be disastrous for efforts to keep full vaccination in Colorado. A direct link to write the Governor can be found here.

So how do naturopaths succeed? They rebrand certain elements of SBM as being “alternative,” as being part and parcel of naturopathy. No, they go further than that, rebranding such science-based modalities as being somehow unique to naturopathy. Dietary interventions become “alternative” and “naturopathy.” Of course, never mind that the dietary recommendations given by naturopaths and science-based nutrition recommendations are all too often related only by coincidence. Naturopaths also appropriate exercise, lifestyle interventions, and counseling as somehow “alternative.” I was reminded of this by a study published two weeks ago in CMAJ by Seely et al., entitled Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. The study purports to demonstrate that the addition of naturopathic care to standard medical care for patients with cardiovascular disease can result in improved Framingham risk scores and is being touted throughout the CAM blogosphere as strong evidence that naturopathy adds something positive to SBM.

Before I get to the study itself, let’s see how pro-quackery propagandists are promoting it, starting (where else?) on that continuingly wretched hive of scum and quackery, The Huffington Post. There, our old friend John Weeks touts the study thusly, while objecting to an editorial that suggested looking at the individual supplements recommended by the naturopaths in the trial:

Yet there was a much better recommendation Stanbrook might have made, given the importance of cardiovascular disease in the high costs of health care.

But why not start by noting that optimal care of most individuals with cardiovascular risk involves multiple etiologies? Care is complex. Of necessity, it demands the kind of individualization of treatment and whole person approaches such as the naturopathic doctors and their integrative medicine brethren practice. A good clinician doesn’t treat patients with lifestyle risks who are at differing levels of readiness for change with the same prescriptions.

Why not, then, Stanbrook might have recommend, [sic] a follow-up in which the naturopathic doctors are working in a primary care capacity, rather than adjunctively, with these individuals. This would not only be money saving. This is in fact typically the way these naturopathic doctors practice their brand of integrative medicine, in Ontario and elsewhere.

Yes, you read it right. Weeks is using this study to argue that naturopaths should function as primary care physicians, despite how well documented it is that they are completely unsuited to such a role, as well done by former regular SBM blogger Peter Lipson in his primary care challenge (also here and here and here). The study, of course, provides support for nothing of the sort, although unfortunately even physicians seem to be taken in by it, as evidenced by the very editorial that Weeks touts, with the cringe-inducing title, Can naturopaths administer complementary preventative care? More on that later. Let’s start with the study by Dugald Seely et al., for which most of the authors were from the Canadian College of Naturopathic Medicine. A finer example of the strategy of naturopaths to try to represent diet and lifestyle counseling as being somehow unique to naturopaths I have not seen in a long time.

The study itself was fairly straightforward as randomized trials go. The subjects were all members of the Canadian Union of Postal Workers aged 25 to 65 years who were under the care of a primary care physician who could speak English and were competent to provide informed consent. The only exclusions were women who were pregnant or breast feeding or who wanted to become pregnant in the the following year. Also excluded were people with a history of myocardial infarction in the last six months, with chronic kidney or liver disease, or with lower relative ratios of total cholesterol to HDL. The study took place at multiple sites, for a total of 246 subjects, 207 of whom completed the study. These subjects were randomized either to either “usual care” by their existing family physician alone or to “usual care” plus naturopathic care. Obviously, the study was not blinded, of course. Rather it was a “pragmatic” trial, which means that pretty much anything goes for both arms. The idea is to compare “usual care” in the community to “usual care” plus naturopathy. One notes that CAM and “integrative medicine” practitioners (particularly fans of acupuncture) love pragmatic trials because they are less rigorous than a true randomized clinical trial.

What’s of interest, before we get to the results, is what “naturopathic care” consisted of.

Participants in the naturopathic group received naturopathic care at 7 preset times over a 1-year period, at a frequency that was somewhat typical of routine naturopathic care in the community. The initial visit was 1 hour, with subsequent 30-minute follow-up visits. For consistency with naturopathic practice, treatment recommendations were individualized from a predetermined menu of interventions based on which risk factors were present and patient preferences (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.120567/-/DC1). Therapies included specific diet and lifestyle recommendations and the prescription of selected natural health products. 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. We did not have direct control over the care given to the control group; thus, we did not track or report recommendations made by the participants’ family physicians.

The menu of therapies was guided by an expert advisory process, during which 4 naturopathic doctors (P.R., R.B., D.L., T.G.) provided guidance to trial clinicians based on existing peer-reviewed published evidence and clinical experience. This process resulted in a trial manual of therapies provided to each of the 3 clinicians (O.S., S.A., C.H.) to guide their practice. The recommended interventions included weight loss of about 2.3–4.6 kg through a combination of caloric restriction and regular physical activity.5,12 Dietary recommendations were based on components of the Mediterranean and Portfolio dietary regimes.13,14 Examples of prescriptions for natural health products included omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid,12,15 soluble fibre,16 coenzyme Q1017 and plant sterols5 (Appendix 1).

It’s telling to look at the menu of interventions. Listed there are lifestyle interventions, which include a weight loss of 5-10 lbs; aerobic and anaerobic exercise, 30 min./d five times a week and two to three times a week, respectively; and 10 min/d of diagphragmatic breathing. The dietary interventions all focused on caloric restriction and decreased fat and red meat intake similar to the Mediterranean and Portfolio diets. In this, there is nothing that isn’t part of SBM. The two links I included went to the Mayo Clinic website and the other is to a WebMD article. Real primary care doctors and cardiologists have been recommending diets rich in vegetables, fruits, and nuts for a long time as a strategy to decrease cardiovascular risk. As for the supplements included on the menu of potential interventions that the naturopath could choose include fish oil, plant sterols, cinnamon, CoQ10, ALA (alpha lipoic acid), lutein, and fiber. So in reality, I wasn’t quite correct to say earlier that “anything goes” in the naturopathic care arm of the trial. In fact, the range of interventions were highly constrained from what naturopaths usually offer, which include not just lifestyle and diet advice, but lots of supplements that go beyond the limited suite of supplements the naturopaths in this study recommended. True, the evidence base for these supplements doing anything for cardiovascular disease is sparse, but they are also probably, as Douglas Adams would say, “mostly harmless.”

Be that as it may, it must also be remembered that “in the real world” naturopaths frequently prescribe acupuncture, traditional Chinese medicine, homeopathy, and all range of woo for treatment of just about everything, the “individualization” of treatment being basically what I like to call “making it up as you go along” or whatever the particular naturopath tends to prefer. So, right from the beginning, it should be clear that what we are looking at is not naturopathic practice but a small subset of what naturopaths do and offer. It’s the Trojan horse, as I like to call it, where the quackery (like homeopathy, chelation therapy, etc.) is hidden in a horse made of seemingly reasonable, science-based recommendations and modalities. Once the horse enters the realm of SBM (ahem, is “integrated” with SBM), then the quackery jumps out of the trapdoor in the bottom and takes over. Even Seely himself works at a clinic that offers reiki, naturopathy, traditional Chinese medicine, hydrotherapy, lymphatic drainage, and more. Indeed, if you want to get an idea of the approach of this clinic, the Ottawa Integrative Cancer Center, you should take a look at this post, in which Seely himself recommends a book by a breast cancer survivor who was treated by a naturopath who gave her intravenous vitamin C (along with other non-evidence-based interventions) between rounds of chemotherapy, endorsing the book as a “profound testament to the possibility of a truly integrative model of care that includes the voices of her dedicated team of healers.”

No, science-based is not what I would call the practice of naturopathy. If anything, the account confirms to me my belief that “integrative oncology” in general and naturopathic oncology in particular are in reality the “integrating” of nonsense with science. Even the naturopathy school where Seely is faculty is steeped in prescientific vitalism (of course it is, it’s a naturopathy school), such as exploring “the manifestation of prana or energetic life force as related to disease in the five sheaths of the body” and, of course, homeopathy.

So what were the results of the study? It wasn’t powered to look at “hard” outcomes like death or myocardial infarctions; instead its a priori defined primary outcomes included changes in the prevalence of metabolic syndrome and changes in the Framingham 10-year cardiovascular risk score. For those not familiar with metabolic syndrome, the Adult Treatment Panel III defines it as the presence of three of five risk factors: abdominal obesity; “triglycerides ≥ 1.70 mmol/L or taking medication for elevated triglyceride; HDL cholesterol < 1.03 mmol/L for men or < 1.3 mmol/L for women; systolic blood pressure ≥ 130mmHg or diastolic blood pressure ≥ 85 mm Hg or taking antihypertensive medication; or fasting blood glucose ≥ 5.6mmol/L or taking medication for diabetes.” The Framingham risk score produces an estimate of risk for major cardiovascular events. Secondary outcomes included changes in individual risk factors, changes in quality of life (estimated by the use of the Short Form Health Survey and the Measure Yourself Medical Outcomes Profile questionnaire). Naturopathic doctors “collected all biometric and validated questionnaire measures at baseline, 26 weeks and 52 weeks for both groups.”

The findings were as follows:

Of 246 participants randomly assigned to a study group, 207 completed the study. The characteristics of participants in both groups were similar at baseline. Compared with participants in the control group, at 52 weeks those in the naturopathic group had a reduced adjusted 10-year cardiovascular risk (control: 10.81%; naturopathic group: 7.74%; risk reduction –3.07% [95% confidence interval (CI) –4.35% to –1.78%], p < 0.001) and a lower adjusted frequency of metabolic syndrome (control group: 48.48%; naturopathic care: 31.58%; risk reduction –16.90% [95% CI –29.55% to –4.25%], p = 0.002).

Of note, also:

Although the treatment group improved more than the control group for almost all secondary outcomes, most were not statistically significant (Table 2 and Appendix 2, available at www.cmaj.ca /lookup/suppl/doi:10.1503/cmaj.120567/-/DC1). Notable significant results were reductions in waist circumference, ratio of total cholesterol to HDL, and scores for symptoms 1 and 2 (self-identified as important symptoms of concern) on the Measure Yourself Medical Outcomes Profile questionnaire, general wellbeing and reduction in medication (number of medications and/or dosage).

Looking at the table, I note that there were 25 measures, each sampled twice after baseline (once at 26 weeks and once at 52 weeks), for a total of 50 measurements. I didn’t see a correction for multiple comparisons; so it’s hard for me to tell whether the number of “statistically significant” improvements are really significant or due to multiple comparisons.

These results lead the investigators to conclude:

According to the American Heart Association, the “prime emphasis in management of the metabolic syndrome per se is to mitigate the modifiable, underlying risk factors (obesity, physical inactivity, and atherogenic diet) through lifestyle changes…Then, if absolute risk is high enough, consideration can be given to incorporating drug therapy to the regimen.”5 Primary health care that provides in-depth counselling around diet and lifestyle is uniquely poised to help comanage metabolic risk factors. We have shown that naturopathic care is a feasible and potentially effective adjunct to usual medical care in reducing the incidence of metabolic syndrome and cardiovascular risk.

No, that’s not what Seely et al. have shown at all. As a cardiologist I know said (and I paraphrase), “If I had four extra hours over seven visits to counsel each patient on lifestyle changes and diet, I bet I could get my patients’ Framingham risk scores and incidence of metabolic syndrome down too.” Indeed, David Winchester, who wrote a response to the study published in the CMAJ, nailed it, pointing out that the authors have not, in fact, demonstrated that the addition of naturopathic care to usual care produces better outcomes, but rather that they have shown this:

While the authors have demonstrated that a generous investment in counseling is effective at reducing calculated CHD risk, they have not demonstrated any effect specifically attributable to naturopathic care. Dietary counseling, for example, appears to be effective regardless of the provider (reference originally published in 2005). (2) As a practicing cardiologist, I routinely “deliver diet and health promotion advice” to my patients and “emphasize this form of self- directed care”. As noted in the accompanying editorial, (3) I would welcome the opportunity to spend an additional four hours in consultation with my high CHD risk patients and I suggest such an intervention would have been the appropriate control comparator.

To these observations, I reiterate what I said above. The suite of interventions from which the naturopaths could choose were not anything unusual outside the realm of SBM. As Dr. Winchester and I agree, the suite included nothing unique to naturopathy, and, as I pointed out, it also left out a lot of outright quackery that naturopaths routinely use, such as chelation therapy. Dr. Winchester also points out something that was eating at me as I read the study. Specifically, he wondered on what evidence the naturopaths based their recommendations. For instance, he questioned the recommendation to cut down on coffee use, given that the available literature before the trial started supported an association between moderate coffee drinking and a reduced risk of diabetes and no increased risk of cardiovascular disease. He also questioned the evidence base for the supplements used, an evidence base that is at best thin.

Perhaps the most disturbing aspect of this trial is how thoroughly CMAJ has bought into the spin that naturopaths are putting on it. Instead of insisting that it be reported to show what it really showed, namely that intense counseling on losing weight and exercising more can potentially decrease cardiovascular risk, its editors significantly bought into the idea that there is something unique about naturopathy. True, Matthew Stanbrook, the deputy editor of CMAJ, did concede my point in his editorial that none of the interventions in the naturopathic medicine arm of this study are, in fact, unique to naturopathy, he flew by that objection to say something even more disturbing:

One might similarly argue that physicians could achieve the same results if they spent an equivalent of 4 hours per year dedicated to cardiovascular prevention with each patient. But that’s the point: this doesn’t seem feasible, given a family physician’s responsibility for overseeing all of a patient’s health issues, and the inability of many Canadians to obtain their own primary care physician based on current physician supply and distribution. In response, physicians already delegate many important aspects of medical care, such as diabetes education, smoking cessation counselling and asthma education, with good effect and in a manner that enhances rather than threatens their therapeutic relationship with patients. The results of Seely and colleagues provide proof of principle that some aspects of cardiovascular prevention could feasibly and effectively be delegated to naturopaths.

No, no, no, no, no! Note that the tasks mentioned by Stanbrook that have been delegated to non-physicians have in general been delegated to specialists who receive science-based training. Dietitians and nurses specializing in diabetes management counsel diabetic patients on diet and insulin use. Nurse practitioners, physician’s assistants, and other mid-level providers are often primarily responsible for lifestyle counseling, asthma education, and routine follow-up visits. Here, the message seems to be that naturopaths are just like these mid-level providers, nurses, or other specialists. The problem is, they aren’t. They’re nothing like them because unlike nurses (except, I must concede, in those nursing schools where therapeutic touch is popular), PAs, NPs, dietitians and the like, their training is steeped in pseudoscience mixed with science, not science-based medicine. For example, as I’ve pointed out before, every single naturopath is required to be trained in homeopathy. Every. Single. One. Of. Them. They’re even tested on homeopathy as part of their board examination. That is not science, and any specialty that thinks that homeopathy can be the least bit science-based is rooted far more in pseudoscience and quackery than science.

The idea that is being promoted by naturopaths is that, if physicians must delegate lifestyle and diet counseling, then naturopaths are somehow uniquely “qualified” to take on the role and fill in the gap. Some, like John Weeks, even argue that this means that naturopaths are capable of filling in for projected shortages in primary care physicians. It’s a common talking point for not just naturopaths, but all manner of CAM practitioners. The hubris is staggering. If we as physicians are, because of the ever more constrained financial imperatives of medicine, no longer able to spend this sort of extra time with patients, then why on earth would we delegate diet and lifestyle counseling to naturopaths? The answer is that we shouldn’t. If delegate we must, then we should delegate to practitioners who are actually trained in science-based interventions, not to practitioners of what is mostly prescientific, vitalistic quackery.

Unfortunately, because of the power of the Trojan horse message, this is a fight we might lose. Shruggies don’t realize this, and politicians don’t understand how much quackery is a feature, not a bug, in naturopathy. It is up to us to educate them.

Posted in: Clinical Trials, Homeopathy, Naturopathy, Nutrition, Science and the Media

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103 thoughts on “The deceptive rebranding of aspects of science-based medicine as “alternative” by naturopaths continues apace

  1. goodnightirene says:

    What people want is “support” because in our food-intensive culture, people who gain weight easily are going to be seriously obese and have a very difficult time shedding it. Most simply cannot do it on their own (most can’t even do it with a ton of “support”), hence the plethora of “diet” books that keep on coming–which in itself should tell people that they are useless (in the long term anyway).

    If naturopaths want to strictly limit themselves to supportive counseling, perhaps they could be useful–but so could a host of other trained counselor-type of professionals. It seems to me that RD’s have largely been left out of this conversation (what to ND’s have against them?). Perhaps RD’s need to add some counseling skills? The one I saw was very helpful, but then she was dealing with someone who wasn’t expecting magic, and if there is one thing I’ve noticed about weight loss attempts, it’s that people want magic.

    There is almost total denial outside the science-trained that it is about CALORIES. Whenever I tell people that I’ve lost significant weight, by eating sensibly, they always want to know WHAT I ate, or lament that they cannot afford “organic” food. My insistence that it’s the AMOUNT of food, not the growing method, and that health and weight loss are not exactly the same thing, pretty much falls on deaf ears, as does my advice to only eat at home (at least for a good stretch) and to measure portions. Portions is where the support counselor comes in, I think. Most people simply do not have the personal discipline (or whatever it is properly called) to go from the kind of portions served at chain restaurants to 1/2 cup of whole wheat pasta, 4 to 6 oz of salmon or chicken breast and 1/2 cup or broccoli for a meal.

    Anyway, I will write to all the links you’ve given to do my part to try to stop the nonsense in Colorado

  2. Angora Rabbit says:

    I love you, Irene. :) I train dietitians and you make exactly the right points about what we expect from our students. I am delighted that their excellent advice is working for you! Let me add that dietitians are required to take both psychology and education psychology courses as part of the didactic training, and receive additional counseling practice and experience in the internship. A double major with psychology is pretty popular. I regularly tell my students that we know how to eat right – the real problem is psychological and getting people to make change.

    As you rightly point out, lay people want the Dr. McCoy quick-fix that solves their problem in the 45min episode. And as you again note, it doesn’t work that way because the bad habits have taken years to accrue. Expecting instant reversal is difficult because it will always be easier to not make the change.

  3. Earthman says:

    As so much of naturopathy is outside the known laws of physics, is it not therefore against the laws of nature, and so unnatural? Its unnaturopathy.

  4. mho says:

    Nasty people: A family owned chain of grocery stores was/is apparently “stakeholders” who were “at the table” in writing these bills and encouraged their customers to be very active in support. Their web page compares both traditional naturopaths and not-a-doctors favorably against medical doctors. They specifically targeted phone calls and emails to an influential Senator who is an M.D.

    They see R.D’s as a guild, and seem to have been major opposition in the past to allow RD’s to be licensed(the only have title protection). They refer to a “dietician monopoly” amendment. (which would have prohibited naturopaths from changing medically prescribed diets–the amend. failed.)

    This grocery is in 6 other states and competes with Whole Foods.

    http://www.naturalgrocers.com/nutrition/naturopathic-medicine-health-care-spectrum

    http://www.naturalgrocers.com/nutrition/regulation-naturopathic-medicine-colorado

    “Medical Doctors have completed training similar to Naturopathic Doctors, but have chosen to specialize in medicine that is heavily dependent on invasive practices and potentially dangerous pharmaceutical drug interventions. MDs tend to have a bias toward suppressing symptoms of a condition rather than supporting the structure and function of body to mitigate its underlying causes. An MD’s standard of care may also be highly modulated by liability concerns, lack of specific training, or insurance reimbursement requirements.. . .The MD’s oath of practice avoids stating that he or she will “do no harm”. “

  5. mho says:

    Nasty people: A family owned chain of grocery stores was/is apparently “stakeholders” who were “at the table” in writing these bills and encouraged their customers to be very active in support. This grocery is in 6 other states and competes with Whole Foods.

    They refer to a “dietician monopoly” amendment. (which would have prohibited naturopaths from changing medically prescribed diets–the amendment failed.)

    “Medical Doctors have completed training similar to Naturopathic Doctors, but have chosen to specialize in medicine that is heavily dependent on invasive practices and potentially dangerous pharmaceutical drug interventions. MDs tend to have a bias toward suppressing symptoms of a condition rather than supporting the structure and function of body to mitigate its underlying causes. An MD’s standard of care may also be highly modulated by liability concerns, lack of specific training, or insurance reimbursement requirements. . . .The MD’s oath of practice avoids stating that he or she will “do no harm”.

    http://www.naturalgrocers.com/nutrition/naturopathic-medicine-health-care-spectrum

    http://www.naturalgrocers.com/nutrition/regulation-naturopathic-medicine-colorado

  6. Naturopathy is becoming integrated into mainstream medicine. Get used to it.
    The push is coming from many directions:

    - The Patients : are tired of the “pill for every ill” medical system designed to maximize profits for the pharmaceutical industry. They demand Healthcare not Sickcare

    - The Medical Doctors: are increasingly rejecting the most harmful practices of Drug-Based Medicine in favour of Holistic Healthcare. Embracing Integrative Medicine, they gain acceptance and credentials in the eyes of patients who are seeking naturopathic remedies.

    - The Health Insurance industry: are recognising that Integrative Healthcare in many cases provides cheaper alternatives to expensive drugs and procedures.

    - Political Leadership: has a looming crisis of Medicare and Medicaid costs to solve. Drug-Based Medicine is a very expensive system to fund, aging population is busting the budget.

    - Finally, conventional medical clinics are overloaded. There are too many patients per doctor and equipment available. Directing some of these patients to a naturopathic practitioner reduces waiting times for everyone.

  7. mho says:

    This was from testimony at the health hearing–

    “Classical homeopathy is the very safest healthcare modality of all . It is supremely suited to the needs of pregnant and nursing mothers as well as infants, babies ,and children . . . .The ultra-high dilution factor of the commonly used remedies, greater than 30 c, guarantees that there is no material substance in the therapeutic agent: no physiological effect on the individual, no chance for allergic reactions or side effects . . .”

    guaranteed– no effect. um- humm.

  8. mho says:

    so @fba, in your backwards universe:

    The [already-well] Patients: demand Healthcare, not [care for the] sick…
    and
    The Medical Doctors. . . gain acceptance and credentials in the eyes of patients who are seeking naturopathic remedies.

  9. mho says:

    sorry about the double post–I thought the first one had been deleted.

  10. mousethatroared says:

    FBA – I can present an argument that flying cars are the only remedy to gridlock in LA – but that argument is not very convincing without evidence that flying cars can actually fly.

  11. David Gorski says:

    Wow. @FBA has parroted pretty much every trope used by naturopaths and other promoters of quackery to try to justify being licensed and even given the privileges and responsibilities of a primary care provider. They’re no more convincing coming from him than they are coming from naturopaths.

  12. weing says:

    From what FBA posted, it looks like the naturopaths want to see the worried well. These patients are neglected by conventional doctors as they don’t need any medication, just some time. Since doctors don’t have time to spend with them, the hucksters want to do that and give them their worthless nostrums.

  13. WilliamLawrenceUtridge says:

    Naturopathy is becoming integrated into mainstream medicine. Get used to it.

    Why? Why should we get used to inferior care that doesn’t actually help anyone and can only increase death rates and the cost of health care? Should we have just “gotten used to” death rates? Personally I’m happy doctors became scientific practitioners, since it resulted in things like vaccines, antibiotics, sanitation, nutrition and reduced maternal and neonatal deaths. I’d rather not get used to the fact that my wife dies in or after childbirth, thanks.

    The Patients : are tired of the “pill for every ill” medical system designed to maximize profits for the pharmaceutical industry. They demand Healthcare not Sickcare

    Sounds like they need to get off their fat asses and exercise, quit smoking, put down the potato chips and in general follow the recommendations of mainstream medicine. I’m not sure what naturopaths add to this. Big Pharma doesn’t force people to take the pills, nor does it force people to be inactive while eating like shit. Not to mention, what are two common interventions of naturopaths to sick patients? Homeopathy (pills) and supplements (pills). Making your point a little hypocritical.

    The Medical Doctors: are increasingly rejecting the most harmful practices of Drug-Based Medicine in favour of Holistic Healthcare. Embracing Integrative Medicine, they gain acceptance and credentials in the eyes of patients who are seeking naturopathic remedies.

    Heh, fact tag. [citation needed]. Drugs aren’t “harmful”, they have “adverse effects” as part of their main effects. If you can figure out a way to get just main effects without adverse effects, you will do an enormous service to the world. Please hurry, people are dying.

    Your comment sounds laudable, right up until you realize that you’re integrating little more than a profit-making machine for naturopaths and integrative practitioners. Their treatments either don’t work, or haven’t been proven to work. How is that better?

    - The Health Insurance industry: are recognising that Integrative Healthcare in many cases provides cheaper alternatives to expensive drugs and procedures.

    That’s superficially true, in that integrative interventions are certainly cheaper than expensive (or even most cheap) drugs and procedures. That doesn’t change the fact that drugs work and integrative practices have no evidence base. Medicine may be imperfect, but at least it is rational. The health insurance industry is, at best, recognizing that it can shut the worried well up with cheap interventions. The fact that the interventions are also worthless is really irrelevant to their bottom line.

    Cheaper is only better if both options provide equivalent results.

    - Political Leadership: has a looming crisis of Medicare and Medicaid costs to solve. Drug-Based Medicine is a very expensive system to fund, aging population is busting the budget.

    You know what would have helped that years ago? A federally-funded public health insurance system. The US pays more than any other country in the world for less effective health care. There’s a lot of work that could be done to improve the incentives and make care better – but adding a bunch of emotion-focussed coping and handwaving doesn’t make things cheaper or better.

    - Finally, conventional medical clinics are overloaded. There are too many patients per doctor and equipment available. Directing some of these patients to a naturopathic practitioner reduces waiting times for everyone.

    One would think the response to all of this would be to train more doctors. I mean sweet Jebus, if the lines are too long at my grocery store, the solution is to open more cash registers – its’ not to tell customers to visualize paying for their groceries.

    It’s a delightful fantasy world you aspire to, and truly you have identified some important issues with current medical care in the United States. I’m just not sure what alternative medicine has to do with either. It would stimulate the economy though, in the same way paying someone to dig holes, then paying someone else to fill them in.

  14. windriven says:

    @Dr. Gorski

    I think I remember correctly that Fast Buck identified herself in an earlier post as a quack, either a homeopath or TCMer. So the adherence to the talking points memo shouldn’t surprise.

    His/her comments above are generally specious though I think, unfortunately, the last one probably has some frightening validity. The political class appears more interested in the appearance than the fact of delivering quality healthcare*. We have a shortage of physician PCPs that is likely to get worse.

    From a political perspective, if a portion of the electorate is happy to embrace frauds and quacks as their PCPs, where is the downside? One might argue that a patient presenting late after consorting with fools and jesters will cost more to treat than one whose disease is diagnosed early and treated conventionally. But I’m not sure the numbers – if they even existed – would support that. A dead patient is pretty cheap to treat (though admittedly a dying one is often quite expensive). In any event, as Jann Bellamy has documented, the trend line is disturbing.

    *A Rasmussen poll publicly released today found that 32% of likely voters rated US healthcare good or excellent. That is down from 55% in May of 2009 but still a shockingly high number given the cost/result ratio of US healthcare versus other OECD countries.

  15. mousethatroared says:

    What’s the name for the logical fallacy where someone thinks that if they can establish that there is a real problem, then their preferred remedy is acceptable, advisable or inevitable?

    Of course if the problem is bad or sad enough, you will get lambasted for questioning the advisability of the preferred remedy.

    The argument often goes something like this – Terrorism is bad. Some terrorist are immigrants. Therefore we must ban immigration. If you are against banning immigration without any evidence of benefit, you are for terrorism.

    That fallacy (or whatever it is) really bugs me.

  16. WilliamLawrenceUtridge says:

    @weing

    I’ve long since seen naturopaths as a form of emotion-focussed coping. I think that’s actually how they should define their profession – as a type of counselor who specializes in medicine or health issues. Not substance, of course, just someone who will listen politely while you talk about your symptoms at length. Won’t change anything, but should help you feel better about what’s wrong with you.

  17. elburto says:

    I think FBA is cute.

    He’s a sort of “troll for all seasons” who wholeheartedly embraces the notion of “The enemy of my enemy is my friend”. In his warped “reality” traditional medically-trained healthcare professionals, who embrace science, are. bad people who have wronged him in some way* Therefore, anyone who takes up arms against these wicked “allopaths” is a welcome ally to FBA, no matter what insane philosophies they espouse.

    Those insisting on the merits of the wonders of the wondrous ‘Health Freedumb’, over the wicked and ebil profiteers** of the BigMedicoPharma cabal, should be forced to accept that path. Not Doctors, homeopaths, chiroquackters et al. should their sole source of “healthcare”. They should go the whole hog and eschew SBM entirely. After all, you don’t go vegan but eat steak when you feel like it, you don’t become a Chassidic Jew and then work on a Saturday.

    The Health Freedummies should have the courage of their convictions.

    Hit by a car? See your chiropractor, get that spine adjusted. Bitten by a snake? Realign those chakras buddy. Don’t let the degloving of your hand in a belt-sander accident become a chance for SBM practitioners to profit!, go and see a homeopath for a holistic, individualised approach!

    *I’ve seen a lot of this in people with functional somatic disorders. Any hint of a doctor not allowing them to lead the diagnosis is somehow “evidence” of corruption or incompetence.

    **$CAM practitioners are in it for love and altruism, and not money. Presumably they rely on a barter system whereby adjusting a “subluxation” is rewarded with a chicken, or a Jerry can full of petrol. A prescription for Nux Vomica is rewarded with some heirloom tomatoes or a jug of raw milk.

  18. Scott says:

    *A Rasmussen poll publicly released today found that 32% of likely voters rated US healthcare good or excellent. That is down from 55% in May of 2009 but still a shockingly high number given the cost/result ratio of US healthcare versus other OECD countries.

    I don’t find that shocking, given that the bulk of the costs are carefully hidden from most individuals. People simply have no clue what their health care really costs, for the most part. Most folks are flabbergasted to hear the fraction of federal spending Medicare represents, for example. Seniors especially.

    Combine that with how allergic the general American public is to any attempt to control costs (generally responded to with “OMG you’re killing Granny!!!”), and it gets downright predictable.

    For that matter, cost bloat probably actively makes people like their health care better, because it’s closer to “you get anything you want.”

  19. windriven says:

    @elburto

    “A prescription for Nux Vomica is rewarded with some heirloom tomatoes or a jug of raw milk.”

    And after quaffing the raw milk they might find they traded vomica for vomare ;-)

    @Scott

    I have stopped marveling at the imbecility of the average American voter. A friend of mine, a retired Marine colonel often asks, ‘doesn’t it scare the sh** out of you to think that half the people are dumber than the average guy?’

    Fear and superstition trump logic and data every time.

  20. mousethatroared says:

    WLU
    “I’ve long since seen naturopaths as a form of emotion-focussed coping. I think that’s actually how they should define their profession – as a type of counselor who specializes in medicine or health issues. Not substance, of course, just someone who will listen politely while you talk about your symptoms at length. Won’t change anything, but should help you feel better about what’s wrong with you.”

    …or it could make you feel worse about what’s wrong with you. How do we know without evidence? Why is it okay to offer quack psychological “treatments” but not okay to offer quack physiological “treatments”.

    Or is there evidence that naturopaths actually have a positive influence on the symptoms of anxiety, hypochondria, functional disorders, etc?

  21. Linda Rosa says:

    It’s my understanding that the Colorado dietitians are opposed to SB-215 (known as variously as the “Health Freedom Bill” and “Safe Harbor Bill”). The dietitians have themselves been unsuccessful in seeking state regulation in Colorado.

    And Colorado’s “degreed” naturopaths certainly are wildly inclusive in their practice, with several offering “cancer treatment.” They have been practicing in the state without interference, which they freely admit to be against the law.

    An informal survey I did about 18 months ago of the websites of Colorado’s ND revealed some common practices, such as homeopath and dietary supplementation, plus a wide array of fringe nonsense.

    http://www.sciencebasedmedicine.org/index.php/night-of-the-living-naturopaths/

    Colorado NDs had been unsuccessful for nearly two decades (i.e. seven tries) in persuading legislators to extend licensure while the Republicans controlled the legislature. This year, the tables turned and the controlling Democrats seemed to intent on passing civil unions and whatever else the Republicans had thwarted in the past.

    From watching these bills, I can say that they definitely NOT consumer driven, and they only reduce consumer protections. There were a number of legislators who testified that they themselves use CAM and the services of naturopaths (the representative from Colorado Springs even gave an impromptu speech on behalf of Burzynski).

    It was pretty clear that the “Health Freedom” bill was offered to the traditional naturopaths so they would halt their opposition to ND licensure which they saw as restricting their practice. That would very much appear to be “log-rolling,” which is illegal in Colorado.

    PLEASE do take a moment to write the Colorado Governor Hickenlooper, urging him to veto these bills. As someone who has campaigned to increase vaccination rates after seeing his infant son contract pertussis, Hickenlooper should be concerned about lending the state’s imprimatur to NDs and other CAMsters.

    To write the Colorado governor, go here ASAP…

    http://www.colorado.gov/govhdir/requests/opinion-leg.html

    …and select “Other” for “Bill.” Then specify HB-1111 (ND regulation) and SB-215 (Health Freedom) in your message.

    Many thanks.

  22. DavidRLogan says:

    Great article. Thanks for going into detail on these trials, Dr. G!

    It’s so depressing I didn’t have anything like SBM ten years ago.

  23. nickmPT says:

    When a patient is a worried well, would we be better off sending them by way of a counselor rather than telling them “you are fine, you don’t need any treatment, just time.” Is it any wonder these patients press on to find someone who will find something wrong and a treatment to fix it?

    How about giving them this instead: “you seem physically fine more or less and I don’t think you need any treatment that I would provide. How about we go about finding someone to help you with your worries?” Then you can proceed to give them counselors info.

    We need to treat the worried well with more compassion and understanding, not just brush them off. I think this would help stop a lot of this ‘natural’ remedy nonsense.

    Thoughts?

  24. mho says:

    @nickmPT

    I agree that worried well need compassion–most are sincerely trying to detect disease early or prevent it.

    I second Linda Rosa’s request–patient protection in Colorado could do with a big dose of emails’s and faxes to the Governor’s office today.

    The worried well are ripe fruit for exploitation and for mis-information.

  25. goodnightIrene says:

    @AngoraRabbit

    Thank you for your kind words. I sometimes wonder if anyone reads my stuff! I only saw my dietician twice and I think I was highly motivated ( just diagnosed diabetic–now gone). But she gave me the essential tools to take action. That was seven years ago, now and Imcan tell you that keeping it off is way harder than losing it!

    Sad RD anecdote. My husband was sent to RD and an extremely fat woman walked into the room. He was amazed, paid little attention, and decided to start listening to me instead. Now we eat the same way instead of keeping two kitchens.

    ——-

    http://www.theheart.org/columns/melissa-walton-shirley-blog/naturopathy-isn-t-magic-it-s-conversation-and-nurturing.do?

    This is a very interesting entry to a cardiology newsletter I subscribe to. It’s a cool coincidence that it came today because it addresses the same topic and fills out what I said in my first comment–or was trying to say. The comments are mostly encouraging too!

  26. marilynmann says:

    If you read the literature on plant sterols, there is actually quite a bit of debate over whether plant sterol supplements are safe or not. One of the reasons for the debate is that there is a rare disease called sitosterolemia in which the transporters that transport plant sterols out of our bodies are defective, leading to high blood levels of plant sterols. This leads to the formation of xanthomas and premature cardiovascular disease. In addition, plant sterols have been found in atherosclerotic plaque removed from the carotid arteries of persons who have undergone endarterectomy and have caused harm in some animal studies. Plant sterol supplements do lower LDL-cholesterol, a surrogate marker, but at the cost of increasing blood levels of plant sterols. Whether that is harmless or not is not known.

  27. Davdoodles says:

    This reminds me of a lot of those fad infomercial weight-loss regimes and dangerous looking ab-bulger-machines which guarantee* that their pills/powders/contraptions will work…

    …provided a whole series of diet and exercise rules are adhered to.

    *not a guarantee

  28. @weing

    From what FBA posted, it looks like the naturopaths want to see the worried well.

    Of course we want to talk to the worried well. It’s called Preventative Care. An ounce of prevention is worth a pound of cure, as an old-school doctor would say.

    The modern MD has no time for preventative care, he’s got 15 minutes per patient to figure out which drug to dispense and send the patient out of the door.

    Lack of preventative care is exactly what turns the Worried Well into the Worried Sick. They receive drugs from the pharma industry to suppress symptoms, they dont receive sound advice for nutrition, lifestyle and health maintenance.

    The study Gorski presented demonstrates the effectiveness of counselling and naturopathic preventative care in cardiology. Of course being an indoctrinated allopath, he spins it around as “a cardiologist could have done all that better”. And that may be true, especially if the cardiologist has preventative care training, and has extensive amount of time for patient counselling. In other words, someone who doesnt exist.

  29. David Gorski says:

    Uh, no. The study demonstrates nothing of the sort, for reasons I explained in detail above. And you’re pulling a straw man here. I never said cardiologists could do it better. I said that it would be much better if mid-level providers, such as PAs and NPs, or trained specialists, such as dietitians and the like, did the counseling, because they are scientifically trained and don’t bring all the quackery to bear that the average naturopath does. The point is that naturopaths are unqualified to do such counseling, and the only reason that this counseling might have been effective in this study is because the naturopaths who designed the study intentionally left out the serious woo in the suite of modalities from which the naturopaths were allowed to choose from.

  30. @David Gorski:

    You suggested cardiologists could do a better job, I didnt make that up, here are your comments:

    As a cardiologist I know said (and I paraphrase), “If I had four extra hours over seven visits to counsel each patient on lifestyle changes and diet, I bet I could get my patients’ Framingham risk scores and incidence of metabolic syndrome down too.”

    And you believe a dietician could do this better than a naturopathic nutritionist? Based on what evidence? The dieticians have designed school canteen programs, addicting the child to processed food of sugar, salt and transfats, that kickstarted an obesity epidemic going from 15% obese population 30 years ago to 40% obese today and 70% overweight. An epidemic of cardiovascular disease with one out of three people suffering from a heart disorder. Sickcare bills projected to rise to one trillion dollars a year.

    And these are the people who are “qualified” to advise cardio patients? I wouldnt trust a “qualified dietician” to feed my cat.

    Bring in the naturopaths, the patients could use some real advice about cardiovascular fitness, organic food, cholesterol metabolism. Drug-based medicine has been in charge of this show for way too long and the results speak for themselves: http://www.jonbarron.org/article/growth-cardiovascular-disease

  31. David Gorski says:

    Uh, no once again. Note that the cardiologist said “I bet I could get my patients’ Framingham risk scores and incidence of metabolic syndrome down too.” Not “better.” “Too.” It was a means of pointing out how the naturopaths are deceptively rebranding normal diet and lifestyle counseling that all cardiologists and primary care doctors do to some extent as somehow being somehow unique to naturopathy.

    Of course, now that you’ve given me the opportunity to reiterate the point, I would go on to say that, when deciding who should do the counseling, it is always better for someone with science-based training who uses science-based lifestyle interventions to do the counseling than a quack like a naturopath, even if the results were equivalent, because at least the patient wouldn’t be subjected to the additional quack interventions that naturopaths like to use, such as homeopathy, chelation therapy, all sorts of supplements that have little or no evidence to support their use, and the like.

  32. @David

    the patient wouldn’t be subjected to the additional quack interventions that naturopaths like to use, such as homeopathy, chelation therapy, all sorts of supplements that have little or no evidence to support their use, and the like.

    Now who is constructing a strawman? Neither chelation therapy nor homeopathy was used in the study. If you read it, what they did use was health promotion counselling, nutritional medicine and dietary supplementation. The control group was receiving standard allopathic care. The naturopath-guided group did much better in reducing their risk of cardiovascular disease.

    The proof is in the pudding -> naturopaths did a better job. This would not be a surprise to you if you actually visited a naturopath for counselling, David, as naturopaths put considerably more time and effort into counselling the patient than the typical 15 minute MD physician hello-goodbye slambam.

  33. weing says:

    “Of course we want to talk to the worried well. It’s called Preventative Care. An ounce of prevention is worth a pound of cure, as an old-school doctor would say.”

    No it’s called Exploitative Care. We practice preventative care all the time. Not really reimbursed much for it, though. My acute care visits are 10-15 minutes. The preventative visits are close to an hour. I don’t know where you get the idea that we just write prescriptions to feed big pharma. I see patients who have seen naturopaths and they bring me all sorts of meds prescribed for them by naturopaths. Meds that I see no need for and others that are worthless. I call that feeding the big alt pharma.

  34. @weing

    I don’t know where you get the idea that we just write prescriptions to feed big pharma.

    Thats what the patients say. Every person who comes to me with a health issue has seen an MD first. Not just the PCP, they would usually see several specialists as well.. endocrinologist, internist, gastroeneterologist.. an average person who comes in has already been “prescribed” by a whole regiment of MDs.

    Misdiagnosed, not taken seriously, given wrong and harmful medication, they lose faith in drug-based medical establishment and come to try the holistic methods. Do we prescribe alt-meds? Yes, but they are mostly harmless. Herbal teas, vitamins, creams, tinctures.

    What naturopathic medications were your patients taking that you believe were causing harm?

  35. Angora Rabbit says:

    @FBA, no, the dietitians didn’t bring you obesity. Try a little edufication. There is a complex web of USDA subsidies, food company interests, restricted budgets, food choices by kids, and a public that listens to nutrition advice with at best half an ear. Most schools haven’t even had dietitians until fairly recently, and the push there is to shift away from processed food to local grown and healthy choices. Our dietetics program is bombarded by excellent school district requests to bring in students who will help set up these programs, and it’s a popular area of grad research.

    But why let facts get in the way of a good rant?

  36. @Angora Rabbit
    The facts are that dietician-designed food products for children led to an obesity epidemic on unprecedented scale. The smoothies, the jumbo pretzels, the sodas, the king size chips, pizza calzones, cheezy puffs, kellogg pop tarts, the milkshakes, the powdered donuts. Thats just the local school canteen menu. Every one of these products had a dietician at the manufacturer company who approved it for human consumption, and another dietician at the school board who approved it for the canteen.

    And these are the “qualified” people that Gorski would put in charge of counselling patients at risk of cardiovascular disease.

  37. Scott says:

    @ FBA:

    Dieticians didn’t recommend any of that. Saying that one was simply on hand doesn’t mean they thought it was a good idea.

  38. BrewandFerment says:

    @FBA:
    “The smoothies, the jumbo pretzels, the sodas, the king size chips, pizza calzones, cheezy puffs, kellogg pop tarts, the milkshakes, the powdered donuts. ”

    I’d start by blaming the purchasers who accustom kids to these things–and sizes–as the norm. Hint: it starts long before kids get to elementary school. In general, day care providers pretty much have to follow FDA recommendations and they don’t include such things, so they’re not the primary cause. I’d probably heave a big chunk of blame at marketers, too. But dieticians? you’re barking at the moon, not even close to the right tree.

    When my eldest went to babysit the early elementary age kids of a friend of mine, we asked about their dinner routine. The mom said that they didn’t usually want to eat dinner, they were in and out of the pantry all afternoon. I guess I looked a bit dumbfounded because she asked me how I kept mine from nibbling on junk…I said there wasn’t much of interest for them in the pantry, mostly flour, sugar, some canned goods, pasta, etc–in other words, ingredients, not prepared snacks. (Now that they are somewhat older, I do keep more handheld snacks in the pantry because they can be trusted not to go gobble half a box of something.) This mom has a bachelor’s degree (not sure in what but still, not an uneducated person) and had a career job before kids. Oh, and surprise, she struggles with her weight. As do I at times, but I recognize the cause: mostly failure to pay attention to quantity and quality of intake combined with lack of activity. She has acknowledged that she knows that, too! she just doesn’t do much about it. And now her kids are overweight. When one of her kids has been over here with one of mine, all offers of healthy food (fruit, milk, kid-friendly veggies like peas or corn) have always been resisted or ignored.

    No, dieticians are not to blame here. And even though marketers get some share of the blame, it’s still really about individual choices. No one is forcing you to supersize.

  39. Angora Rabbit says:

    Actually, foods are designed by food chemists. Dietitians are clinicians that are conversant with food composition and dietary analysis. Where I am these are separated into two very different departments. At other institutions they can be melded into one department, but the disciplines are very different.

    I’m with Irene; I’m done feeding the troll.

    And well, said, BrewandFerment. Two of my favorite pastimes as well. :)

  40. WilliamLawrenceUtridge says:

    The facts are that dietician-designed food products for children led to an obesity epidemic on unprecedented scale. The smoothies, the jumbo pretzels, the sodas, the king size chips, pizza calzones, cheezy puffs, kellogg pop tarts, the milkshakes, the powdered donuts.

    When I was a kid, we had a cafeteria. I made my lunch every day and didn’t eat any of that stuff. Perhaps it’s different in Canada, but eating at the caf was a privilege determined by your parents providing money or you spending your own. I chose not to spend the money because my parents taught me that it was wasteful and unhealthy.

    Big Farmer isn’t forcing me to stuff fries in my face, not now and not when I was a kid. I learned how to eat from my parents, my schooling, and the recurrent nutritional information I have been bombarded with throughout my life, which always emphasized fruits, vegetables, whole grains, milk and small servings of meat.

    Straw. Man. Troll. Much of the blame for people being fat-asses is ignoring the instructions on how to eat a healthy diet, and ignoring the need for regular exercise. Don’t pretend doctors would rather give their patients a pill than a diet. Liar.

  41. mousethatroared says:

    FBA “@FBA:
    “The smoothies, the jumbo pretzels, the sodas, the king size chips, pizza calzones, cheezy puffs, kellogg pop tarts, the milkshakes, the powdered donuts. ”

    Wow! Dietician’s are behind all that? I thought they were just into pushing the green beans, salad and discouraging bacon*. Suddenly dietitians seem a lot more fun. If someone tells me that dietitians are behind the Caipirinha, then they will be my new besties.

    *I don’t know what they have against Kevin Bacon, Footloose was cool.

    WLU – Hot lunches were pretty good when I was in school and they had these awesome buns…sad.

  42. mousethatroared says:

    WLU “Much of the blame for people being fat-asses is ignoring the instructions on how to eat a healthy diet, and ignoring the need for regular exercise.”

    I think this is as simplistic as saying an that an anorexic is to blame for starving themselves.

  43. @mousethatroared

    I think this is as simplistic as saying an that an anorexic is to blame for starving themselves.

    THe patient will usually get into an anorexic condition, but the dietician will make sure they stay there:
    http://answers.yahoo.com/question/index?qid=20081217070510AA8qEUv

  44. mousethatroared says:

    FBA – Oh, well – if someone on Yahoo Answer’s had a bad experience with an incompetent dietician, then they must ALL be bad, then.

    This is the point were we just ditch all professions, because I’m pretty sure that someone on some web site somewhere has encountered a poor representative of any given profession.

    Except rodeo clowns, no one’s stupid enough to bad mouth with a rodeo clown, even anonymously.

  45. WilliamLawrenceUtridge says:

    I think this is as simplistic as saying an that an anorexic is to blame for starving themselves.

    And about as accurate – both are behavioural disorders, both involve behaviour that can be controlled by the individual, though not easily, and both have significant inputs from society. Simple, simplistic, yes. But also true. It’s not that I don’t have a certain amount of sympathy (particularly for people with anorexia), but having gained and lost weight myself and settled on a rigorous exercise routine, excellent diet and accepted the fact that having a six-pack just isn’t worth it. Yes, my comment is trivializing, but that doesn’t change what truth there is in it, and it doesn’t change the fact that the individuals in question are ultimately responsible for their own behaviours.

    FBA – yahoo answers isn’t a resource. Particularly when it says a dietician would recommend a 250 calories per day diet to someone with anorexia. That’s concentration camp-level starvation. Any more straw men you want to knock down?

  46. mousethatroared says:

    WLU “And about as accurate – both are behavioural disorders, both involve behaviour that can be controlled by the individual, though not easily, and both have significant inputs from society. ”

    Where did you get that Anorexia is a behavioural disorder?

  47. @WLU

    Particularly when it says a dietician would recommend a 250 calories per day diet to someone with anorexia. That’s concentration camp-level starvation.

    I was impressed that she weighed the patient with coat and shoes on to show “progress in weight gain”.. on a 250 calorie diet! haha, Gorski must be proud of cutting edge science based dietitionery there!

  48. WilliamLawrenceUtridge says:

    Where did you get that Anorexia is a behavioural disorder?

    The same way drug addiction is a behavioural disorder – it involves a behaviour the patient controls. From a Skinnerian perspective, “behavioural” actually means “psychological”. Psychology controls the behaviour but ultimately it is the behaviour you want to change. Again, not saying it isn’t easy, particularly given the specific mental circuits involved (eating, like sex, obviously involves extremely primitive and extremely complex neurological loops), but ultimately you want to change behaviour. Neither obesity nor anorexia are the kind of conditions where you just want the patient to feel better about their existing affliction.

  49. LogicLad says:

    @FBA

    Because clearly a single incident of poor advice means that the whole industry is invalid, just as well you don’t see homeopaths proscribing anti malaria medicine, i mean that would be shamefully poor service for their customers

    http://news.bbc.co.uk/1/hi/programmes/newsnight/5178122.stm

    Sorry I don’t know how to make the above a real hyperlink

  50. Jan Willem Nienhuys says:

    These subjects were randomized either to either “usual care” by their existing family physician alone or to “usual care” plus naturopathic care. Obviously, the study was not blinded, of course.

    But instead of usual care the patients might be randomly assigned to either ‘naturopathic care’ or to a couple of sessions with

    Nurse practitioners, physician’s assistants, and other mid-level providers

    or dietitians. And then also 7 half-hour sessions in a year. If you compare, then you should try for a comparable control group. Looks to me like a serious error in the design of the test.

    I see in stories like this often that one arm gets “usual” care and the other arm “usual care plus extra attention”. Without knowing what is being examined and what the treatment consists of, one may expect the “usual care” to do worse. Especially if the investigators don’t know what they are looking for and have the liberty of including or leaving out any of 20 outcome measures (altogether over a million possibilities…)

  51. LogicLad says:

    @LogicLad

    Looks like this system is cleverer than I am and can recognise a hyperlink.

  52. mousethatroared says:

    WLU – I can’t even look up your claims because neither google, wikipedia or med-pub shows any results for anorexia nervosa behavioral disorder and neither the DSM or the ICD list anorexia nervosa as a “behavioral disorder”.

    Do you have a citation?

    here is the ICD criteria – http://www.mentalhealth.com/icd/p22-et01.html
    here is the DSM criteria with elaboration from Cleveland Clinic – which I have found to be a good source of science based medical resources. – http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/eating-disorders/#cesec9

    Also, I’d like to point out the fact that I said anorexia, not anorexia nervosa, so we skipped the differential diagnoses that distinguishes different causes of anorexia, such as cancer, tumors, intestinal disorders, auto-immune diseases, diabetes, drug side effects, etc from anorexia nervosa….Just as there is a differential diagnoses in weight gain or being a “fat ass”. Also we haven’t discussed co-morbidities, such as anxiety disorders, depression, etc. This is part of what makes the issues, not as “simple” as “They know what to do, they just won’t do it.”

    Can we skip the Dr. Laura Schlessinger approach and admit that some issues are complicated and have diverse causes and mechanisms? Can we say that treatment approaches should be tailored to fit the individual patient’s needs and diagnoses. Perhaps combating an eating disorders requires specialized knowledge, techniques and sometimes medications that the regular person doesn’t get from an average education or life experience. Perhaps that is why it’s not advisable to have anybody off the street treating people with eating disorders, but, you know, doctors, psychologists and dietitians.

  53. mousethatroared says:

    WLU – “it involves a behaviour the patient controls. From a Skinnerian perspective, “behavioural” actually means “psychological”.

    There’s a reason it’s call Cognitive Behavior Theory. It’s because a good bit of it is changing automatic thoughts.

  54. @ Jan Willem Nienhuys

    If you compare, then you should try for a comparable control group. Looks to me like a serious error in the design of the test. I see in stories like this often that one arm gets “usual” care and the other arm “usual care plus extra attention”.

    Yes Jan, but thats exactly what happens in the real world – the patients who go to conventional care get “the usual” while the patients who go to naturopath get “the extra attention”.

    The study reflects what happens in actual clinical practice quite accurately.

  55. WilliamLawrenceUtridge says:

    @MTR

    Yup, I agree with all your points (particularly your distinction between anorexia and anorexia nervosa, I meant only the latter). I will stand by my statements to a limited extent – the problem is conceptually simple (obese people need to expend more calories than they consume, anorexia nervosa patients need to consume more calories than they expend, both must adjust their eating once they reach a certain weight). Actually achieving these conceptually simple solutions is devilishly complex and both are fairly intractable problems, and in the case of anorexia nervosa I would support anything but a comprehensive, expert solution with experienced clinicians and other professionals. Obesity…for the most part I have less sympathy for.

  56. Jan Willem Nienhuys says:

    fba writes

    exactly what happens in the real world

    that doesn’t condone fraudulent research that aims at providing ‘proof’ that the specific treatment of a bunch of scammers has any value beyond what any kind of personal attention can do.

    Ben Goldacre has complained that one of the twenty tricks pharmaceutical companies apply in trials is that they set up tests in which ‘the other arm’ is arranged in a fashion that almost guarantees that their own stuff shows up as the good stuff. This is just fraud. But it is rampant everywhere where the researchers have an agenda – such as ‘proving’ some kind of sCAM works.

  57. FrancoisT says:

    “I don’t find that shocking, given that the bulk of the costs are carefully hidden from most individuals. People simply have no clue what their health care really costs, for the most part.”

    Must be why my wife, who is a disease manager, is confronted every day with people who can’t afford needed treatment or have to take their medications once q2days instead of 1 qday, or skip on their blood sugar strips.

    That’s what anyone would call costs that are carefully hidden, no doubt about it!

  58. LogicLad says:

    @FBA

    You seem to be missing the point being made by many people here, it was not anything thats was specifically natropathic that hepled, it was the extra consultation time. This time was used to deliver entirely science based advice on health and diet.

    As someone further up the thread suggests, this study actually shows that what is needed is more qualified MD’s so that they can spend more time with patients.

    What is not needed is Natropaths pretending that the fact that they can do some science based medicine means that the reality free aspects of their treatments are worthwhile. I belive elswhere on this blog someone made the analagy to adding apple pie to cow pie, no matter how much apple pie you add, it still is not something you want to eat.

  59. @LogicLad

    The study finds that patients who visited naturopaths improved a lot more than patients who visited MD’s.
    Yes there is a shortage of MDs and we need more doctors, but the critical finding of the study is – the doctors need training in naturopathic medicine to improve patient care.

  60. WilliamLawrenceUtridge says:

    Yes there is a shortage of MDs and we need more doctors, but the critical finding of the study is – the doctors need training in naturopathic medicine to improve patient care.

    Troll, you can keep pretending that was the finding of the study all you want, but that doesn’t make it true. Of all the interventions used, many are clearly mainstream (exercise, lose weight, eat less saturated and trans fats, consume more healthy foods), some are borderline (take fish oil supplements and fibre) and the remainder are essentially neutral (consume spices and juice). The finding of the study was that several hours of nutritional counseling per year increases compliance and results in improved health scores. If you gave a similarly limited menu to doctors, they would probably drop most of the neutral ones and get the same results. This isn’t naturopathy, this is naturopaths, and you, troll, deceptively pretending doctors don’t recommend diet and lifestyle changes.

  61. Jan Willem Nienhuys says:

    LogicLad writes

    more qualified MD’s so that they can spend more time with patients

    Not necessarily so. The extra time spent might just as well by others than MDs (PA, RN, dietitians…), but of course these consultants should be qualified. ‘Naturopaths’ cannot be called qualified, unless their interventions have been shown to have beter results or at least the same results as interventions by qualified regular personnel in a fair test.

    A common pro-sCAM argument is that these scammers take more time for their clients. An example is the case of homeopaths who often need a first session of 60 or 90 minutes for a full ‘anamnesis’ (with questions like ‘are you afraid of thunderstorms?’ ‘do you sleep on the right or on the left side?’ ‘do you like your tea hot or lukewarm’) and follow-up sessions of 30 minutes. Those who argue for the enormous benefits of all this extra attention usually don’t emphasize that these scammers charge for the extra time, and pretty steep rates too. An ordinary GP tries to keep consultation time to 10 minutes. If they (and other MDs) would increase this to 30 minutes, you would need three times as many MDs and the costs of healthcare would soar to incredible heights.

  62. @WLU

    Of all the interventions used, many are clearly mainstream (exercise, lose weight, eat less saturated and trans fats, consume more healthy foods), some are borderline (take fish oil supplements and fibre) and the remainder are essentially neutral (consume spices and juice).

    Oh mainstream are they… so why the group that went to the MDs for advice have not received the benefit from this mainstream treatment? Right, cause they didnt get any of this mainstream treatment from the drug pushers.

    Keep on spinning excuses for results that dont fit your agenda and denying the evidence. Which is exactly what Gorski did in his article.

  63. Scott says:

    The study finds that patients who visited naturopaths improved a lot more than patients who visited MD’s.

    False. The data equally well support the interpretation that patients who got more counseling did better than patients who got less. And THAT interpretation has a much higher prior plausibility than the one that delusional quacks completely disconnected from reality are actually useful.

  64. @Scott

    The data equally well support the interpretation that patients who got more counseling did better than patients who got less. And THAT interpretation has a much higher prior plausibility than the one that delusional quacks completely disconnected from reality are actually useful.

    Baloney. The data showed exactly what I said – the group that was treated by the naturopaths improved more than the group that didnt.

    That this was due to more counselling is Gorski’s idea, plausible but not proven.
    I am not sure why I bother, you guys remind me of a religious cult.

  65. Scott says:

    It’s equally true to say “the group that got more counselling improved more than the group that got less.” Since that is true, it is completely false and unjustifiable to conclude that the fact they were NDs had anything to do with it.

    I am not sure why I bother, you guys remind me of a religious cult.

    You’re the one who claims to be practicing magic.

  66. Jan Willem Nienhuys says:

    fba wrote:

    The data showed exactly … Gorski’s idea, plausible but not proven

    The use of the word ‘showed’ suggests that the data provided sone kind of proof for a general statement. This is reinforced by a further remark containing the word ‘proven’.

    But the test was fraudulent. The design of the test was such that the statement ‘the group that was treated by counselors whose surnames start with an N improves more than the group who only got usual care’ would have fair chance of being ‘proven’ as well.

    What about the statement ‘the group that was treated by Americans improved more than the group that didn’t'? This is also what the data showed exactly.

    If you think that people whose surname starts with N give superior advice, then you should of course state that in advance, and then take care that the control group contains the same kind of advisors, but with another surname. If you think that Americans do better, then you should have a control group with non-Americans (but exactly the same remaining qualifications). If you think that naturopaths do better, then you should have in your control group other non-MDs that give comparable advice and attention.

    If you don’t design the test in that way and still pretend the outcome means something you are incompetent or fraudulent or both.

    In some cases it is might be hard to come up with a suitable control but in this case a suitable control group would not have been so hard to organise. So the verdict is ‘intentional fraud’. The result is meaningless.

  67. @Jan..

    There was nothing wrong with the test. One group received naturopathic care, the other group didnt. The physicians had full freedom to provide any advice they wanted to the patient, and spend as much time as they deemed necessary. They didnt provide enough counselling?? Well thats their fault, they certainly had full opportunity to do so.

    The test was studying if naturopathic counselling sessions reduce a patient’s risk of developing cardiovascular disease, and the result was clear – they do.

    If you and Gorski think PAs and dieticians could have done the same – where is the EVIDENCE.

  68. Scott says:

    The test was studying if naturopathic counselling sessions reduce a patient’s risk of developing cardiovascular disease, and the result was clear – they do.

    Wrong, wrong, wrong, wrong, wrong! The test was studying ONLY if generic counselling sessions do so. They had NO WAY AT ALL to compare naturopathic counselling to any other form. As has been repeatedly explained to you, in precise detail.

    The physicians had full freedom to provide any advice they wanted to the patient, and spend as much time as they deemed necessary.

    Did you even read so much as the abstract? The control was usual care plus biometric measurement. NOT “spend as much time as they deemed necessary.”

    If you and Gorski think PAs and dieticians could have done the same – where is the EVIDENCE.

    This study provides no evidence whatsoever either way as to whose counselling is better.

    What you’re trying to do here is take the study that was actually done, completely redesign it to answer a completely different question than it actually asked, assume the difference between control and intervention group would have been the same, and then draw conclusions based on that. In other words, make up random unsubstantiated BS.

    Oh wait, the random unsubstantiated BS already exists – it’s what naturopaths and homeopaths do every day.

  69. WilliamLawrenceUtridge says:

    Oh mainstream are they… so why the group that went to the MDs for advice have not received the benefit from this mainstream treatment? Right, cause they didnt get any of this mainstream treatment from the drug pushers.

    The results are rather clearly a result of an inappropriate control group. One group got seven extra hours of encouragement and advice. Perfectly mainstream advice. Give 7 extra hours to the MD-only group, and you’ll see comparable gains. Calling this “naturopathic care” in the absence of anything “naturopathic” is simply wrong. Bar supplements of dubious worth, this is mainstream care given an environment of greatly enhanced resources.

    By the way, you’re still ahead of yourself, you’re not supposed to revert to sarcastic trolling for another couple months of pretending to be reasonable.

  70. weing says:

    “The physicians had full freedom to provide any advice they wanted to the patient, and spend as much time as they deemed necessary.”

    Did they? How come when I refer patients to dietitians, they won’t go because the insurance won’t cover the counseling? I agree usual care is insufficient and more dietary and lifestyle counseling is necessary for better outcomes. I’m hoping that this will change with Obamacare. In fact, with the ACO my group is involved in, we are working on and putting our own money into this type of intervention, ie. lifestyle and dietary counseling, with the hope that it will pay off in decreased costs.

    This was a study designed by naturopaths to make themselves appear good. A tactic often used by big pharma to get results they want. A real study would be usual care vs. usual care + naturopathic counseling vs usual care + dietary and lifestyle counseling. More interesting would be naturopathic counseling and treatment without usual care compared to usual care, but that would be unethical.

  71. WilliamLawrenceUtridge says:

    Did they? How come when I refer patients to dietitians, they won’t go because the insurance won’t cover the counseling?

    The doctors did not have full freedom to provide advice or spend time. The study was conducted in Ontario. I live in Ontario. Despite a provincially-funded public health care system, doctors are constrained in how much time they have with each patient. We may get longer appointments than US patients, but there are still prominent signs in most doctors’ offices that state visits are limited to addressing a single issue. In most cases, comparing “usual care” to an extra layer of intervention is not a reasonable control. But this is only an issue if you are interested in testing whether there is a genuine difference. The authors, and Fast Troll Artist, are not. Also, science generally tests single parameters – such as just oil or CoQ10 supplements. Once the single supplement is established as effective, then combinations might be tested. Real science would ensure the individual possible parameters were effective (which in some cases they are – exercise and weight loss are unambiguously associated with better cardiac health) rather than assuming they were. Cinnamon, I believe, is not an established treatment for heart health. For all we know, the entire set of statistically significant results may be due purely to increased consumption of fatty fish. The study answers very few questions, none well, and certainly doesn’t vindicate naturopathy as an approach. If naturopaths solely restricted themselves to the interventions listed, I’d have a lot less of a beef with them than I actually do – but they don’t. They oppose vaccination to greater and lesser degrees, accept homeopathy, treat with acupuncture and dose with supplements of uncertain purity and unnecessary expense. This study vindicates and proves none of the latter.

  72. pmoran says:

    The study referred to “Naturopathic medicine”, yet, as Dr Gorski and others have pointed out, that is a serious misnomer. To the extent that any of the methods employed have been established to reduce cardiac risk, that is known from sophisticated conventional scientific research, not from naturopaths sitting behind their desks and somehow, with supreme improbability, keeping track of long-term outcomes in an ever-shifting patient population.

    As any doctor knows, the difficulty with cardiac risk is not knowing what to advise, it is gaining patient compliance, especially with the “big ticket” items: diet, weight loss, and exercise. For all I know, naturopaths may be good at this. Perhaps they tantalise their clients with glimpses of a Holy Grail of health, — you know, — the Wellness kind of thing. The big trick lies in being able to keep patients coming back, either for encouragement, or for scolding if they relapse.

    It is also true that tablets are the easy option for doctors. They should reduce cardiac risk regardless of anything else, so why not? I am sure most doctors also advise regarding healthy lifestyles, or use dieticians, but they know in their hearts that most people will eventually relapse.

    This may be one of several ways in which CAM practitioners can plausibly help some people who for a variety of reasons including unlucky choice of doctor may not be well served by the mainstream. It does no harm to allow that, — it can only add force to our cautions concerning the many risks of CAM.

    All the above is preamble to my main thought that we desperately need to be doing more to attack poor lifestyles at source, within the family, in schools and wherever else lifestyles are being evolved. We in the mainstream probably are too preoccupied with treatment rather than prevention. Yet, what to do? What will work? Any advice re that, FBA?

  73. norrisL says:

    Why can’t we just put the naturopaths and the legislators who encourage them in jail for fraud?

  74. FrancoisT says:

    Juicing is quackery?

    Who knew?

  75. @weing

    A real study would be usual care vs. usual care + naturopathic counseling vs usual care + dietary and lifestyle counseling.

    It would be fair from scientific point of view, yes, and I welcome the idea that MDs could provide the dietary and lifestyle counselling with same or even better results than the naturopaths. Growing number of MDs, and some that I work with, are embracing Integrative Medicine, and holistic medicine, and this trend is growing, eventually this study will be obsolete as naturopathic methods merge with conventional care.

    @pmoran

    We in the mainstream probably are too preoccupied with treatment rather than prevention. Yet, what to do? What will work? Any advice re that, FBA?

    Conventional medicine has no incentives to provide preventative care. Sick people buy products and pharmaceutical corporations spend billions of dollars to keep patients sick and buying products. This has been well documented by pharma insiders on this issue. To maximize pharmaceutical sales, Healthcare has been turned into Sickcare, the sick get their symptoms treated, the healthy get nothing. They call them “worried well” here, with disdain, like there is something wrong with healthy people trying to stay healthy.

    Naturopaths get much better patient compliance because they put patient health first. The naturopath is like a personal trainer for the patient, a partner, which is what conventional doctors used to be, 50-60 years ago, before pharmaceutical money perverted the system, turned primary care into 10 minute pharmaceutical product sales sessions.

    Preventative care has been relegated to pseudodoctors like “dieticians” who tell people “Eat less calories”, cause thats a person suffering from malnutrition (obesity is a form of malnutrition) needs, more malnutrition! :| Then they say — these darn patients, they just dont comply! Of course they wont comply, you are feeding them baloney! Naturopaths have known from traditional herbal medicine that colonic bacterial balance is key to digestive malabsorption problems, been called quacks all the way, now that mass spectrometry technology has emerged we are discovering microbiological evidence for what natural healers knew for 1000 years.

  76. FrancoisT says:

    @pmoran wrote:

    “We in the mainstream probably are too preoccupied with treatment rather than prevention. Yet, what to do? What will work?”

    A reasonable solution is health coaching, where the emphasis during training is put on client enlisting, engagement and behavior modification toward more healthy choices.

    There is also the Certified Diabetes Educators out there who, alas, experience all sorts of obstacles when comes the time to 1) get a reasonable income for their services and 2) being accepted as bona fide health care professionals (only MDs PharmDs, RNs can be CDEs) who can truly help diabetic patients stay in the straight and narrow.

    One thing is absolutely sure: chronic diseases and eating disorders are complex physiologic, sociological and emotional problems that have VERY LITTLE to do with “lack of moral fiber” or “laziness” or “absence of discipline”. Yet, too many people, even among health care professionals harbor such detrimental prejudices.

  77. Chris says:

    FrancoisT:

    Juicing is quackery?

    Well fiber is very important. It helps to keep the colon healthy. Plus juices are just flavored sugars (fructose, sucrose) suspended in water.

    ;-)

  78. pmoran says:

    The naturopath is like a personal trainer —-

    Unfortunately, no health care system and few individuals can afford personal trainers.

    On the other hand, the most important aspects of known preventative health care can be written on the back of an envelope and taught in schools, in the home, on TV and the Internet. It should not be necessary to pay anyone for the basic information.

    So I say, if we can just find some way of improving the take-up of these measures during childhood, there will be considerably less need for personal trainers, drugs, bypass surgery and many other wasteful aspects of health care.

    Naturopaths have known from traditional herbal medicine that colonic bacterial balance is key to digestive malabsorption problems, been called quacks all the way, now that mass spectrometry technology has emerged we are discovering microbiological evidence for what natural healers knew for 1000 years

    This is definitely the wrong place to make ridiculous claims. Apart from the absurdity of any malabsorption state enabling excess deposition of body fat, some of us have been following the claims of herbalists for decades, while also being well-informed about the history of medicine and the evolution of scientific medical knowledge. Back up these claims if you can.

  79. @pmoran

    Unfortunately, no health care system and few individuals can afford personal trainers

    Can they afford heart surgery, diabetic medication, orthopedic knee reconstruction, blood pressure medication, etc..? Preventive care pays for itself many times over in future saved sickcare costs, many studies have demonstrated this.

    Apart from the absurdity of any malabsorption state enabling excess deposition of body fat, some of us have been following the claims of herbalists for decades

    I didnt say malabsorption causes deposition of body fat. I said colonic bacterial balance is key to digestive malabsorption problems. Please read carefully. We can also discuss how to treat deposition of excess body fat with natural non-toxic methods, drug-free, we have complete solutions in naturopathy for this problem, And they dont involve starvation or malnutrition of the patient that dieticians are so fond of.

  80. Jan Willem Nienhuys says:

    Scott writes

    The test was studying ONLY if generic counselling sessions do so.

    this is in correct.
    1. Look at the title of the article:
    “Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial”
    (note the oxymoron ‘naturopathic medicine’ in the title)
    2. from the abstract: “trial to evaluate the effectiveness of naturopathic care”
    In non-fraudulent trials ‘effectiveness’ means ‘how much better does it work than a placebo or a known treatment’.
    One compares to placebo in an effort to exclude all kinds of interactions between patient and caregiver with a generic effect due to (extra) attention and suggestion. If a manufacturer of a new unproven medicine presents a ‘trial’ in which the control group was not even given a placebo, the result has to be pretty strong (e.g. mortality going from 100% to 50%) otherwise such a result should be laughed away.
    3. The authors and the lead author are mostly naturopaths and the lead author is too.
    4. The conclusion “hypothesis that the addition of naturopathic care to enhanced usual care…” points again to what hypothesis was being tested. I think I am going to do ‘science’. I am going to show that candle light improves map reading abilities. I will take 246 volunteers, and let them read maps in a moonless night in a forest, half of them with ‘usual lighting conditions’ and half of them (adequately randomized of course) I will provide with a candle and matches. Afterwards it turns out that 207 didn’t cheat by using their phone for illumination, and I will try to get my article “Hydrocarbon based illumination as assistance for general orientational deficiency: a randomized practical trial” past some naive referees in a medical journal.
    4. As David Winchesters remarked: “Dietary counseling, for example, appears to be effective regardless of the provider” so the authors knew or could have known how to construct an appropriate control group.

    I repeat: this investigation should be classed under intentional fraud, because the authors deviously and knowingly organised an inappropriate control group.

    Personally I think that comparing to an equal amount of dietary counseling was deliberately avoided because the authors didn’t want to run any risk whatsoever that naturopathic counseling would come out worse than regular care.

  81. weing says:

    In FBA’s world, if bacteria can be killed off by listening to patient’s concerns, obesity can be evidence of malnutrition and malabsorption. Natural healers apparently discovered bacteria before the microscope was invented. These guys are good. Only at making a fast buck.

    Diet and lifestyle changes have always been part of science based medical care and are not something discovered by alties but claimed by them as being their own. We can do fine without their mumbo jumbo and big alt-pharma products.

  82. Scott says:

    @ Jan:

    True – I was referring to what they ACTUALLY studied, not what they CLAIMED to be studying.

  83. WilliamLawrenceUtridge says:

    In FBA’s world, if bacteria can be killed off by listening to patient’s concerns, obesity can be evidence of malnutrition and malabsorption. Natural healers apparently discovered bacteria before the microscope was invented. These guys are good. Only at making a fast buck.

    I’m actually confused about Fast Troll’s world. Does s/he have doctors following him/her around, preventing him/her from eating anything that’s not an organically-raised, five-ingredient home-made meal? Or do they start every visit with repaglinide wrapped in a cheeseburger, covered with mayonnaise so it slides down without chewing?

    My last physical consisted of “keep doing what you’re doing, you’re an appropriate weight and your diet is excellent”. Nary a pill to be prescribed. It’s almost like my reality is completely different. Almost fictional. Like his/her comments are being posted from a parallel universe where medicine doesn’t make any sense. Or like s/he’s never actually been to a doctor, merely heard about them from some sort of propaganda-mill.

    @pmoran

    The big trick lies in being able to keep patients coming back, either for encouragement, or for scolding if they relapse.

    The big trick might be having patients who pay for naturopathic care out of pocket. For one thing, they would be more likely to have more money, or expensive insurance. For another, if they’re paying out of pocket, they would probably be more motivated to adhere to the recommendations. For a third, they may be better able to take time away from work to visit a naturopath or generally undertake preventive care. For a fourth, naturopaths probably attract the worried well anyway. Or, specifically about this study, the “treatment” group just got a whole lot more attention. There are a lot of potential confounds in this study, to the point that you can’t really use it to say anything.

    I also question your claim that good medical advice isn’t freely available. There are no magic bullets, there is no one intervention that guarantees perfect health and immortality. We know and have known for decades what a healthy diet and lifestyle is – food you cook yourself from basic ingredients, fresh fruits and vegetables, not too much, with exercise. This is not hidden information available only to initiates, this is basic health care advice that is advertised the world over. Chasing down nonsense like cinnamon to treat diabetes delays the realization that your diabetes will go away if you eat better and exercise. Supplement pushers are substituting their poorly-proven medications for prescription medications, but both types obscure the fact that a lifestyle change is required – which again, has been basic medical advice and knowledge since Galen.

    eventually this study will be obsolete as naturopathic methods merge with conventional care.

    “Naturopathic” methods become conventional care when they are scientifically proven to be effective. Conversely, they are rarely dropped by naturopaths since their practice is not evidence-based the same way actual medical treatment is. And this study was obselete before it was published. “Dur, maybe if we give people encouragement, they’ll be more likely to comply with treatment advice” – YOU THINK!?!? And in other news, water is wet and good for your health.

  84. pmoran says:

    Unfortunately, no health care system and few individuals can afford personal trainers

    FBA: Can they afford heart surgery, diabetic medication, orthopedic knee reconstruction, blood pressure medication, etc..? Preventive care pays for itself many times over in future saved sickcare costs, many studies have demonstrated this.

    In the short term any approach is going to be an ADDED cost for health care systems and there have to be more practical and cost-effective options than providing entire populations with a personal naturopath..

    It is also not clear that preventive health care does “pay for itself” in the long run, and as any general rule (vaccinations are a probable exception). Those whose cardiac events are prevented will go on to get other illnesses and require expensive aged care and pensions. For governments the most cost-effective option is a sudden fatal heart attack at about retirement age, when the ability to pay tax lessens.

    I didnt say malabsorption causes deposition of body fat. I said colonic bacterial balance is key to digestive malabsorption problems. Please read carefully. We can also discuss how to treat deposition of excess body fat with natural non-toxic methods, drug-free, we have complete solutions in naturopathy for this problem, And they dont involve starvation or malnutrition of the patient that dieticians are so fond of.

    Well, the following is exactly what you said, and that I suggested you “Back up these claims if you can.”

    Preventative care has been relegated to pseudodoctors like “dieticians” who tell people “Eat less calories”, cause thats a person suffering from malnutrition (obesity is a form of malnutrition) needs, more malnutrition! :| Then they say — these darn patients, they just dont comply! Of course they wont comply, you are feeding them baloney! Naturopaths have known from traditional herbal medicine that colonic bacterial balance is key to digestive malabsorption problems, been called quacks all the way, now that mass spectrometry technology has emerged we are discovering microbiological evidence for what natural healers knew for 1000 years.

    Obesity may be a little more complex than calorie balance but not to the extent that we have to redefine well-used medical terms or credit ancient healers with knowledge they could not possibly possess and never displayed at the time.

  85. WilliamLawrenceUtridge says:

    For once I agree with you Pete. Not to mention, personal trainers are not going do a damned thing for someone having an acute heart attack. You can’t compare acute and chronic conditions as if they were interchangeable, and you can’t incentivize chronic care the same way you can acute. There’s a reason people make dramatic changes after heart attacks – surgeon’s general warnings and vague statistics are nowhere near so personally terrifying as having a metaphorical elephant step on your chest. And I strongly doubt that the impact of gut bacterial activity has such a dramatic impact on obesity as, say, eating lots of fruits, vegetables and whole grains and getting daily exercise. Assuming that study’s results are replicated, in humans, if they can narrow down the difference, I doubt it will be a difference of as much as 100 cal/day.

  86. windriven says:

    @pmoran

    Peter, you waste your time and energy with that meatloaf.

    “now that mass spectrometry technology has emerged”

    What a guffaw. Mass spectrometry was in widespread use when I was an undergrad in the early 70s.

    “we are discovering microbiological evidence for what natural healers knew for 1000 years.”

    Yeah, I’ll bet there are hundreds of homeopaths burning the midnight oil running experiments on GCs and MSs.

  87. WilliamLawrenceUtridge says:

    @windriven

    Sure is amusing to see Pete playing devil’s advocate for the other side though, isn’t it?

    As I’ve argued before, even if homeopaths in years past noted that certain people gained weight more than others, I would wager a pretty penny that they didn’t attribute it to bacteria, nor did they attempt to treat obesity with yogurt.

  88. @pmoran

    It is also not clear that preventive health care does “pay for itself” in the long run, and as any general rule (vaccinations are a probable exception). Those whose cardiac events are prevented will go on to get other illnesses and require expensive aged care and pensions. For governments the most cost-effective option is a sudden fatal heart attack at about retirement age, when the ability to pay tax lessens.

    This is a very disturbing view of the world – that retired folks are nothing but unproductive moochers on healthcare costs. You can be old and healthy and productive. Preventative care doesnt just affect retired people, but also working-age adults and children.

    My interest in natural medicine started when in younger days I was mountaineering with an anthropologist in countries of south east asia. The rural areas we visited had no access to pharmaceuticals, electricity or imported food. They lived off the land and used native plants for medical remedies administered by the village herbalist. In these villages, I havent found a single case of obesity, or autoimmune disorder, not one case of allergy or asthma. There were sick people, but certain western health disorders were completely absent.

    I wasnt certain at the time if it was their lifestyle or the herbalists’ skills that made a difference, but it gave me an idea which disorders plaguing the western world are primarily a result of modern nutrition and pharmaceutical abuse, and the areas where naturopathic treatment can have the most impact.

    Obesity is one such disease. It’s an entirely manufactured disease, designed by dieticians and food chemists who concocted the toxic products lining up the shelves of supermarkets, full of transfat, refined sugar and no nutrients. The same dieticians and chemists who poisoned their victims from childhood, then turned to blame the victim – you are just eating too many calories you lazy slob, eat less! Thyroid problem, what are you taking for it, chocolate cakes?! Tv Shows popped up like “The Biggest Loser”, a sadistic race to starve and fatigue the obese patient in the fastest possible time, sending a clear message to the viewer – if you want to get healthy, its going to be painful and its going to be exhausting.

  89. pmoran says:

    It is also not clear that preventive health care does “pay for itself” in the long run, and as any general rule (vaccinations are a probable exception). Those whose cardiac events are prevented will go on to get other illnesses and require expensive aged care and pensions. For governments the most cost-effective option is a sudden fatal heart attack at about retirement age, when the ability to pay tax lessens.

    FBA:This is a very disturbing view of the world – that retired folks are nothing but unproductive moochers on healthcare costs. You can be old and healthy and productive. Preventative care doesnt just affect retired people, but also working-age adults and children.

    Oh, agreed. The point is that naturopaths cannot avoid the political, economic and practical constraints that prevent doctors from performing as well as they might in an ideal world. It is a matter of fact that few practitioners can have much influence on lifestyles during the most formative years, especially against peer groups and family.

    In a free country we also have limited ability to restrict access to those great tasting foods and drinks that provide unneeded and “empty” calories. I live in an area of very high obesity rates and I would set my observations of how my countrymen fill their shopping trollies up and spend most of their time against your interpretations of what you observed during your Asian visit. This is minimally judgmental — poor diet and little exercise are facts of modern life. Your references to primitive and historical populations have little or no relevance.

    And in the long run it comes down to what is shown to work — that is, precisely which factors serve to prevent or treat obesity. Theorising can only get us so far.

  90. pmoran says:

    Peter, you waste your time and energy with that meatloaf.

    It could be equally argued that it was irrational of you, WLU and others to respond in the first place. No one comments here without having an axe to grind and the expectation that they will be able to hold their ground (in their opinion) in any subsequent debate. So I ask, when have you ever seen anyone abandon a firm opinion about CAM (either way) as the result of a few days’ exchange on the Internet? It just doesn’t happen.

    So I have few expectations, but my own limited objectives.

  91. BillyJoe7 says:

    Sorry, I’ve lost my patience.

    “I wasnt certain at the time if it was their lifestyle or the herbalists’ skills that made a difference, but it gave me an idea which disorders plaguing the western world are primarily a result of modern nutrition and pharmaceutical abuse, and the areas where naturopathic treatment can have the most impact”

    A classic example of an ignorant and opportunistic fool pulling ideas out of his nether regions for fast bucks.

    Money for nothing and my $#|t for free.
    Money for nothing and my $#|t for free.
    Money for nothing and my $#|t for free.

  92. windriven says:

    @pmoran

    “It could be equally argued that it was irrational…”

    True enough. But hope springs eternal. And it isn’t really the tools like Th1Th2 and Fast Buckie that motivate responses. It is for those who aren’t band-edge, those who read the posts and read the comments but don’t write; those who are trying to understand the issues and define their own positions. It is arguably important not to allow non-scientific arguments stand unchallenged until their authors have amply demonstrated themselves to be dufuses (dufi?) after which further intercourse is pointless.

    ” So I ask, when have you ever seen anyone abandon a firm opinion about CAM (either way)…”

    Well, I can only speak for myself. But I had the firm opinion that honey as a treatment for open wound infections was sCAM idiocy. Mark Crislip disabused me of that in, as I recall, a comment on one of the other bloggers’ posts. And Karl Withakay (I think) caught me in a logical inconsistency that caused me to reevaluate some of my thinking on the political application of libertarian philosophy.

  93. David Gorski says:

    So I ask, when have you ever seen anyone abandon a firm opinion about CAM (either way) as the result of a few days’ exchange on the Internet? It just doesn’t happen.

    About CAM in general? No. About specific CAM treatments? Yes.

    Yes, I have seen people change their minds about specific CAM treatments after a few days’ exchange on the Internet. It might be unrealistic to expect that minds can be changed about CAM itself, but it is quite possible to persuade people that specific CAM modalities don’t work. It’s a start, and every little bit helps.

  94. WilliamLawrenceUtridge says:

    My interest in natural medicine started when in younger days I was mountaineering with an anthropologist in countries of south east asia. The rural areas we visited had no access to pharmaceuticals, electricity or imported food. They lived off the land and used native plants for medical remedies administered by the village herbalist. In these villages, I havent found a single case of obesity, or autoimmune disorder, not one case of allergy or asthma. There were sick people, but certain western health disorders were completely absent.

    And this was somehow an indictment of “all Western medicine”? “Western” medicine, about as meaningful as “Jewish physics”, is based on empiricism – there’s nothing “Western” about it. And don’t give me any crap about “holistic”, science breaks processes down into their simplest components then rebuilds it into a comprehensive understanding of the whole system. The fact that this is complicated and time-consuming doesn’t mean it’s wrong, merely incomplete. “Western” science can provide a pretty good understanding of your observations – farming is hard work, non-industrial agriculture doesn’t tend to produce massive food surpluses, farming routinely “trains” the immune system to avoid autoimmunity due to exposure to numerous viruses and bacteria, and the truly sick will die of their illnesses without real medical care. I wonder if you would have been as impressed at witnessing a child choking to death due to influenza, asthma or anaphyalctic shock? Truly do you not understand the problem of a selective sample.

    Obesity is one such disease. It’s an entirely manufactured disease, designed by dieticians and food chemists who concocted the toxic products lining up the shelves of supermarkets, full of transfat, refined sugar and no nutrients.

    The products aren’t toxic, and dieticians and food chemists don’t force consumers to eat them. Transfats have been removed from many products on the basis of scientific findings that demonstrate they are as bad for you as saturated fats. Refined sugars are recognized as obesogenic and official recommendations are to consume in moderation, if at all (a statement that goes for juice as well). Foods are often fortified with nutrients, but standard recommendations are for diets rich in fresh fruits and vegetables – not cheetos.

    The same dieticians and chemists who poisoned their victims from childhood, then turned to blame the victim – you are just eating too many calories you lazy slob, eat less! Thyroid problem, what are you taking for it, chocolate cakes?!

    Yep, that sounds about right – obese people need to eat fewer calories or get more exercise, or ideally both. What’s your alternative?

    Tv Shows popped up like “The Biggest Loser”, a sadistic race to starve and fatigue the obese patient in the fastest possible time, sending a clear message to the viewer – if you want to get healthy, its going to be painful and its going to be exhausting.

    Yep, also true. Getting healthy is indeed painful and exhausting if you’ve got a lot of weight to lose. You’ll need to go to bed hungry, move more than you are used to, consume fewer processed foods and in general change your lifestyle. When someone is 400 pounds overweight, it’s going to take a lot of work to get rid of it. Supplements won’t help. The obese got that way by eating too many calories and not burning enough. Yes, there’s a lot of other factors, but at its core that is the issue. Bar a very small number of genetic conditions, obesity is the result of years of caloric imbalance. It would be nice if losing weight were easy, but it’s not because it’s a fight between a calorie-rich environment and millions of years of evolution. We are not ideally suited to our current environment, and pretending it’s all the fault of evil corporations doesn’t magically make people exercise more.

  95. @WilliamLawrenceUtridge

    I wonder if you would have been as impressed at witnessing a child choking to death due to influenza, asthma or anaphyalctic shock?

    I witnessed plenty of health problems in these native populations, a lot of infections for example that are unheard of in the modern environment (thanks to vaccination, water sanitation, hygiene). If you read carefully, I said certain western health disorders were absent. Not all. Certain.

    Obesity is one such disorder. Not a single obese person was sighted in these villages, really I havent seen even one. Not for lack of food, they had food in good quantity. They ate in moderation. Just like western people once did, if you look at old black and white school class photographs, you’ll notice not a single obese child to be found.

    The body has natural neuroendocrine regulation system of food intake, which works through the brain-gut neural network to regulate appetite. When a healthy person consumed enough nutrient-rich food, intestinal and pancreatic satiation peptides are released and gastric hormone ghrelin to send a signal to the brain to stop sending stuff in the mouth.

    In the late last century, food companies spent millions of dollars for teams of food chemists and dieticians to break the body’s satiation system, to find how to addict people to food. Toxic brews were fed to rabbits to discover what keeps their appetite going. Products were developed that are addictive and disruptive to appetite regulation by design. Then billions of dollars have been spent marketing this toxic rubbish to children, the younger the better.

    Obesity is a manufactured disease epidemic, designed in labs, trialled on mice and rabbits, and distributed to children. The same dieticians who designed the addictive high-caloric zero-nutrient slop, then turned to blame the victim for the ensuing obesity epidemic – there is nothing wrong with our product, you just need to eat it in moderation! Where else did I hear this crap, oh yes, from cigarette manufacturers! Create the most addictive poison, Mass market it to children and finally blame the victim for the consequences! See, it’s not our fault some users get addicted, they just need to smoke in moderation! The big lie in all this of course is the product is specifically designed to break the body’s systems of moderating food intake!

  96. pmoran says:

    David: Yes, I have seen people change their minds about specific CAM treatments after a few days’ exchange on the Internet. It might be unrealistic to expect that minds can be changed about CAM itself, but it is quite possible to persuade people that specific CAM modalities don’t work. It’s a start, and every little bit helps.

    Yes, people do change their minds about some aspects of CAM after reading skeptical literature, but that in itself implies a prior inclination to submit to the authority of scientific evidence or opinion. Such folk will respond to sound information. SBM, Quackwatch and other sites provide that well enough.

    There is another subgroup of readers/commenters, to which FBA belongs. They are usually quickly recognizable . They may be suspicious of scientific authority and more deeply immersed in CAM philosophy. Their beliefs are possibly being constantly reinforced by either the plaudits of patients or the support of their own blogs and friends.

    Can they be influenced? I believe yes, but it may take a very long time, if ever, with much tilling of the soil if seeds of doubt can take root, possibly years later. Any change may be limited — to a rather wiser, clearer understanding of mainstream medicine, or a better understanding of the limitations of what they do, but even that would be worthwhile.

    So I do question the level of ad hominem, name-calling, and the “this discussion is beneath us” going off in a huff that occurs here in response to the inevitable 9and expected) frustrations of such engagements. No one is forced to talk to these people in the first place (they have probably already heard most of your arguments, anyway), and it is always possible to bow out with a polite and dignified “well, you have my opinion, and why I hold it, — I can do no more”.

    That is as much as we can do, and it is probably how we express ourselves and what kind of people we seem to be that determines its impact as much as anything else.

  97. WilliamLawrenceUtridge says:

    You can pretend all you want that it’s all the evil dieticians faults. But I grew up with access to these same foods, I am an adult who regularly buys and eats these foods in moderation, and somehow I’m not obese. You’re pretending and blaming companies. Last I saw, at no time did companies ever forcefeed their products to anyone but rats.

    Also, all those cigarette smokers who existed during the 40s, 50s and 60s, when cigarette smoking was at its peak? They managed to quit.

    People are not helpless. It is difficult to change. But it’s up to the people to do so.

    And peasant villages had nothing close to the same access to calories that modern people do. They must ration their food, since their ability to access the first-world network of foods was probably nil due to a combination of financial resources and a distribution network. Not to mention farming without mechanization is a lot of exercise.

  98. mousethatroared says:

    WLU “You can pretend all you want that it’s all the evil dieticians faults. But I grew up with access to these same foods, I am an adult who regularly buys and eats these foods in moderation, and somehow I’m not obese. You’re pretending and blaming companies. Last I saw, at no time did companies ever forcefeed their products to anyone but rats.”

    Ehhh? First, I’m no expert, but a few thoughts. Don’t you think a corporation has any responsibility? They are making money off selling some of these unhealthy foods, are they at all responsible to offset the risks to the community with ANY action or contribution?

    Here’s the thing that makes me uncomfortable. The economics seem to be skewed from what one would like to encourage healthy eating. So, due to the cheapness of HFCS sugary (often low nutrition foods) are often cheaper than high nutrition foods like fruits, vegetable, meats…I think proteins like beans are the exception.

    Evolutionarily (danger will robinson) we are programmed to prefer sugary, fatty, salty foods, since those were more scarce until pretty recently. Now the sugary, fatty, salty foods are more common and the “healthy” foods that were less scare are more expensive. If one wanted to set up an economic model to encourage obesity…what would it be?

    At the minimum maybe we should examine our government subsidies and school lunch programs to make sure that they are not encouraging a less healthy market dynamic.

    I know that you (WLU) previously dismissed the school lunch programs as optional or a luxury item, but in the U.S. the school lunch program is used to feed children in lower income levels. For some children, it is the primary meal of the day. The nutritional content is important, especially to children of low income families. (In my son’s former school, about 40% of the children received free “hot” lunch for economic reasons).

  99. mousethatroared says:

    Just to clarify, not only do coorporation make money of selling unhealthy foods, people’s evolutionary appetite is an incentive for them to make food more unhealthy…it’s not an economic model that encourages healthy eating.

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