Status where status is not due

“By granting self-regulation, we’re attesting, as elected representatives, to the public that we believe the practices that will be engaged in by professionals are safe and that they’re effective and that they meet the highest possible standard.

The above statement was made earlier this year by the Alberta Health Minister, Fred Horne, during a press conference to announce the granting of regulated status to naturopaths. The mood at the press conference, which received a good deal of coverage, appeared to be upbeat and positive. It was portrayed as a good-news story. It was, apparently, a victory for those who want more health-care options. It was a victory for patient choice, autonomy and open-mindedness.

My reaction was somewhat less than positive.

The granting of regulated status – which includes the creation of the College of Naturopathic Doctors of Alberta – may seem a relatively benign political act. It will lead to more standardization and, I guess, promote safety.

However, it may also foster a misunderstanding about the services provided by these practitioners. It may create the impression that the therapies are supported by good science. It casts a veil of legitimacy over the work of naturopaths and, one could argue, implies that all services that are offered are efficacious. Indeed, Minister Horne was explicit. He said that the granting of self-regulation demonstrates to the public that the Alberta government “believe[s] the practices … [are] effective.”

Really?

Welcome to the world of pseudoscience

Allow me to lay my admittedly love-of-science-rant-tainted cards on the table. In general, the services provided by naturopaths reside either in the realm of commonsense lifestyle advice (get lots of sleep, eat well and stay active!) or they

have little empirical evidence to support their use. In fact, many naturopathic practices are based on a semi-spiritual theory (the healing power of nature) and have no foundation in science. They reside largely in the realm of pseudoscience.

Am I being too harsh? I recently worked with a University of Alberta colleague on an analysis of the web sites for the naturopaths in Alberta and British Columbia. We wanted to get a sense of what is being offered to the public. In Alberta, the number-one most commonly advertised service is homeopathy.

Homeopathy has been around for hundreds of years. The basic philosophy behind the practice is the idea of “like cures like.” A homeopathic remedy consists of a natural substance – a bit of herb, root, mineral, you get the idea – that “corresponds” to the ailment you wish to treat. The “active” agent is placed in water and then diluted to the point where it no longer exists in any physical sense.

In fact, practitioners of homeopathy believe that the more diluted a remedy is, the more powerful it is. So, if you subscribe to this particular worldview, ironically, you want your active agents to be not just non-existent, but super non-existent.

The bottom line: For those of us who reside in the material world, where the laws of physics have relevance, a homeopathic remedy is either nothing but water or, if in capsule form, a sugar pill.

How homeopathy conflicts with the laws of physics and chemistry

Of course, “like cures like” and super dilution have absolutely no foundation in science. There is no evidence to support the idea that the active agents – the herb, root, mineral – correspond in any biologically meaningful way to the particular ailments that the homeopathic treatments are meant to treat. (One popular homeopathic web site nicely illustrates the ridiculous nature of this idea by saying, “[I]f the symptoms of your cold are similar to poisoning by mercury, then mercury would be your homeopathic remedy.”

Of course, the idea that a super-diluted solution could have some measurable impact on our bodies conflicts with the known laws of physics and chemistry. If a homeopathic solution contains no true ingredients, how can it have a physical impact on the body? (This is not the same thing as using a vaccine, where there is an actual biologically active agent present that interacts with our immune system.)

One might argue that, sure, from a scientific perspective, homeopathic remedies sound silly, but who cares if perhaps in some instances they do work?

What does the clinical evidence actually say?

Here’s why: Because despite claims to the contrary, there are hundreds of studies on homeopathy. What the good research consistently tells us is that homeopathic treatments do not work any better than placebos do.

For example, a 2002 systematic review – a rigorous analysis of all available evidence – concluded that the best available evidence “does not warrant positive recommendations for its use in clinical practice.” A 2010 review of the “best evidence” concluded that homeopathic remedies have no “effects beyond placebo.” Even the U.S. National Institutes of Health National Center for Complementary and Alternative Medicine, an entity that has a specific mission to be open-minded about unconventional treatments, concluded, “[t]here is little evidence to support homeopathy as an effective treatment for any specific condition.”

To be fair, there is observational evidence that suggests that patients who seek out homeopathic remedies often feel better, but research tells us that, as with many alternative treatments, this is likely nothing more than the placebo effect – which is, no doubt, a powerful force.

In summary: There is no evidence that homeopathy works, and given the absurd nature of the proposed mechanism of action, no scientifically plausible reason that it should work.

Some might argue it is unfair to analyze homeopathy and use that to critique naturopaths. Homeopathy is a “treatment” so obviously devoid of scientific merit that it is consistently mocked on TV shows, by comedians and, of course, by skeptics.

Welcome to bogus treatment endorsed by a pandering government

Nevertheless, for naturopaths, homeopathy is not some fringe practice utilized by a few rogue clinics that have decided to shun modern science. Homeopathy is central to naturopathic medicine. The web site for the newly formed Alberta college has a picture of an attractive naturopath dispensing what looks to be a homeopathic solution. The text under the picture proudly notes the use of homeopathy. The president of the new college reiterated this message in the speech he delivered after Minister Horne gave his speech. And, of course, it is a practice that is taught in Canada’s leading school of naturopathic medicine.

When Minister Horne tells the world that the Alberta government believes that the practices of naturopaths are effective, he is talking about homeopathy. This is not implied legitimization of a bogus treatment; this is official and overt legitimization of a bogus treatment.

Every time I speak or write about the pseudoscientific nature of homeopathy, I elicit one of three reactions. Reaction one: It is alleged that homeopathy does work (this is usually in the form of “It worked for me!”) and that I must be in the pocket of Big

Pharma. Two: It is noted that many remedies provided by conventional doctors also do not work any better than placebos do, and I must be in the pocket of Big Pharma. Three: I must be in the pocket of Big Pharma.

These arguments do not take us very far down the road of rational debate. To simply assert something works does not make it so. Moreover, personal experience is the most unreliable form of evidence. Indeed, in many ways, the scientific method was developed to fight the perverting influence of personal perceptions.

“Big Pharma” and “Big Naturopath”: Both have vested interests

The claim that many conventional therapies are ineffective is absolutely true. And pharmaceutical interests – and, for that matter, other corporate interests – have had a terrible impact on the way evidence is produced and used. Many forces and vested interests twist what we hear about biomedical research but embracing unproven therapies does not help this situation. On the contrary, it moves health-care policy in the wrong direction – further away from science and empirically provable, efficacious and safe treatments.

The public should not forget that many special interests also exist in the context of homeopathy and naturopathic medicine. The makers of homeopathic remedies want to turn a profit just as much as any pharmaceutical company. After all, homeopathic solutions are not made by water fairies and distributed free of charge. Nor do naturopaths donate their time and services.

How to puncture bias and vested interests: Return to the scientific method

There are biases and vested interests everywhere. One should be aware of these biases, but their existence does not help prove that homeopathy works. In fact, the concern with vested interests should push us toward, not away from, a reliance on the scientific method. It is the use of carefully constructed scientific studies and the dispassionate assessment of available data that will ultimately tell us what works – whether we are talking about conventional or alternative therapies.

Many caring and thoughtful alternative practitioners will likely continue to assert that homeopathy is effective, but the argument that 2+2=5 is still incorrect no matter how sincere, caring and “holistically” motivated the proponent. The values or disposition of the proponent may be relevant to questions of bias, but not, in the end, to whether a claim of efficacy is accurate.

I do not know if my arguments will convince a single person to stop using homeopathy. Homeopathy is a faith-informed practice and, as such, largely impervious to rational argumentation. No amount of evidence (and there is a mountain of it) will convince advocates that homeopathy is merely water. But I do hope that, in the future, provincial governments across Canada will take more care in the way they address these regulation issues – that is,  unless they wish to abandon evidence-based approaches to health care and embrace the supernatural and pseudoscientific.

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Timothy Caulfield is the Canada Research Chair in Health Law and Policy; a professor in the Faculty of Law and the School of Public Health, University of Alberta; and the author of The Cure for Everything: Untangling the Twisted Messages about Health, Fitness and Happiness. Twitter: @CaulfieldTim