MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

While my last post was about the risk following some naturopaths’ advice, this one is about the effectiveness of naturopathic treatments. This is a complex subject, not least because naturopaths use a wide range of therapies (as the name implies, they pride themselves of employing all therapeutic means supplied by nature). Some of these interventions are clearly supported by good evidence; for instance, nobody would doubt the effectiveness of a healthy diet or the benefits of regular exercise. But what about all the other treatments naturopaths use? The best approach to find an answer might be to assess not each single therapy but to evaluate the entire package of the naturopathic approach, and not a single study but all such trials.

This is precisely what US researchers have recently done. The purpose of this interesting, new systematic review was to compile and consolidate research that has investigated the whole practice of naturopathic medicine as it is practiced in community settings in order to better assess the quantity and quality of the research, and clinical effect, if any.

In order to get included into the review, studies had to report results from multi-modal treatment delivered by North American naturopathic doctors. The effect size for each study was calculated; no meta-analysis was undertaken.

Fifteen studies met the authors’ inclusion criteria. They covered a wide range of chronic diseases. Most studies had low to medium risks of bias including acknowledged limitations of pragmatic trials. Effect sizes for the primary medical outcomes varied and were statistically significant in 10 out of 13 studies. A quality of life metric was included in all of the RCTs with medium effect size and statistical significance in some subscales.

The authors concluded that previous reports about the lack of evidence or benefit of naturopathic medicine (NM) are inaccurate; a small but compelling body of research exists. Further investigation is warranted into the effectiveness of whole practice NM across a range of health conditions.

This sounds like good news for naturopathy! However, there are several important caveats:

  • the authors seem to have only looked at US studies (naturopathy is a European tradition!),
  • the searches were done three years ago, and more recent data were thus omitted,
  • the authors included all sorts of investigations, even uncontrolled studies; only 6 were RCTs,
  • rigorous trials were very scarce; and for each condition, they were even more so,
  • the authors mention the PRISMA guidelines for systematic reviews implying that they followed them but, in fact, they did not.

My biggest concern, however, is something else. It relates to the interventions tested in these studies. The authors claim that their results table provides full details on this issue but this is unfortunately not true. All we have by way of an explanation is the authors’ remark that the interventions tested in the studies of their review included diet counseling and nutritional recommendations, specific home exercises and physical activity recommendations, deep breathing techniques or other stress reduction strategies, dietary supplements including vitamins, hydrotherapy, soft-tissue manual techniques, electrical muscle stimulation, and botanical medicines.

Survey data from two US states tell us that the most commonly prescribed naturopathic therapeutics are botanical medicines (51% of visits in Connecticut, 43% in Washington), vitamins (41% and 43%), minerals (35% and 39%), homeopathy (29% and 19%) and allergy treatments (11% and 13%). They also inform us that the mean length of a consultation with an US naturopath is about 40 minutes.

I think, this puts things into perspective. If I advise a patient with diabetes or hypertension or coronary heat disease to follow an appropriate diet, exercise and to adhere to some stress reduction program, if in addition I show empathy and compassion during a 40 minute consultation and make sure that my advise is taken seriously and subsequently adhered to, the outcome is likely to be positive. Naturopaths may elect to call this package of intervention ‘naturopathy’, however, I would call it good conventional medicine.

The problem, I think is clear: good therapeutic advice is effective but it is not naturopathy, and it cannot be used to justify the use of doubtful interventions like homeopathy or all sorts of dodgy supplements. Testing whole treatment packages of this nature can therefore lead to highly misleading results, particularly if the researchers draw unwarranted conclusions about specific schools of health care.

6 Responses to Good news for naturopathy? No, not really!

  • Everything to make Type II diabetic eat less and exercise more, because Type II diabetes is not an accident and typical patient does not believe in exercises weight loss, legumes (or endocrinologists are complaining about public ignoring such a healthy group of foods) and it is extremely difficult to convince that no posh fish-oil capsules will save them from aterosclerosis and diabetic foot. Or fat sea fish – they will point out that mainstream doctors are talking how good these are, and will not listen to someone telling that fat is fat – if you eat to much of it….
    HOWEVER apart from (maybe) promoting change of lifestyle, naturopathy will not help in case eye, kidney etc. problems, that have developed as result of diabetes, however naturopath may convince patient that mainstream medicine who has learned to deal with diabetic retinopathy, neuropathy etc. is a crap.

  • http://neurobonkers.com/

    Forty minutes of friendly smoozing may explain loyalty to naturopathy more than anything.

    Some doctors’ bedside or office-side manner could can be off-putting. Con artists can be very sympathetic.

  • You and other sources often make the point that diet and exercise are part of conventional medicine and I agree. You also add, as do others, that eating a balanced diet and exercising are good advice. Again I agree. I think the problem I see is that twofold: Firstly, naturopaths and MD’s are not likely to give the same advice in these areas, especially diet. MD will send you to a registered dietician whereas the naturopath (who claims to be a “nutritionist” or “nutrition expert”) will give you all sorts of odd prescriptions to follow and the odd prescriptions will vary greatly among naturopathic practitioners.

    Secondly, MD’s will not usually send anyone to the RD unless a diagnosis of diabetes Type II is given (I’m in the US). Short of that, you will get, “eat a balanced diet”. While not wrong, this is not very helpful to a lot of people and you can see why they are so easily taken in by the sympathy, magical suggestions, and rituals the ND has to offer. The ND will talk on about miracal berries, supplements, but not calories. S(he) will talk (and test for) of allergies, toxins, and negativity, refer to popular books with faddish principles, but not calories.

    The difference is that the MD expects you to take responsibility for your weight, including addressing psychological problems. The ND will blame anything but the client

    • And naturopaths often have vague idea about bioavailability of nutrients and, especially, cooking (my father has studied cooking science). But not everybody know this.

  • Thank you for covering that one. Another case of garbage in and garbage out. Who do they think they are fooling? Answer: uneducated consumers.

    I give it 3 out of 3 on Jon Stewart’s 3 types of bullsh*t:

    http://www.bustle.com/articles/102772-transcript-of-jon-stewarts-bs-speech-from-the-final-daily-show-shows-his-incredible-last-pieces

  • “We thank Boiron SA, Messimy, France for a non-binding financial contribution.”
    Non-binding support must mean there were no conflicts of interest.

    At least these children had self limiting problems which usually resolve with palliative care in 7-10 days. This is only a little less outrageous than “studies” done using homeopathic preparations on third world children with life threatening diseases. They did manage to demonstrate that homeopathy is as effective as real medicine in cases where real medicine is contraindicated because it is ineffective.

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