Monthly Archives: October 2021
The 13th European Congress for Integrative Medicine is about to take place online between 4 and 7 November 2021. It will host 125+ speakers presenting from around the world. The programme will cover the following topics.
- Anthroposophic Medicine
- Arts in Healthcare
- Antimicrobial Resistance
- Covid Research
- Integrative Oncology
- Lifestyle Medicine
- Medical Education
- Mental Health & Stress Management
- Mind and Body Connection
- Mistletoe Therapy
- Nutrition, Gut Health & Microbiome
- Pain Management
- Patient Activation & Self-Management
- Planetary & Environmental Health
- Research and Evaluation
- Social Prescribing
- Traditional Health
Even looking at the more detailed list of lectures, I did not find a single contribution on conventional medicine (“Integrative medicine combines conventional medicine with…” [see below]) or a lecture that is remotely critical of integrative medicine. The definition of INTEGRATED MEDICINE (IM) adopted here seems similar to the US definition we recently discussed. Here is the European definition:
Integrative medicine combines conventional medicine with evidence-informed complementary medicine and therapies to achieve the optimum health and wellbeing of the patient. Focusing on a holistic, patient-centred approach to healthcare, it takes into consideration the patient’s physical and psychological wellbeing and treats the whole person rather than just the disease.
Allow me to do a quick analysis of this definition by looking at its key elements:
- Evidence-informed: While proper medicine is BASED on evidence, IM is merely INFORMED by it. The difference is fundamental. It allows IM clinicians to use any un- or disproven so-called alternative medicine (SCAM) they can think of or invent. The evidence for homeopathy fails to show that it is effective? Never mind, IM does not need to be evidence-based, it is evidence-informed. IM physicians know homeopathy is a placebo therapy (if not they would be ill-informed which would make them unethical), but they nevertheless use homeopathy (try to find an IM clinic that does not offer homeopathy!), because IM is not EBM. IM is evidence-informed!
- Therapies that achieve optimum health and wellbeing. This is odd because the website also states that “therapies can include anything from acupuncture, yoga, massage, aromatherapy, herbal medicine, nutrition, exercise along with many more approaches, tailored to the needs of the individual” indicating that virtually anything can be included. Anyway, “optimum health and wellbeing” seems a strange and unachievable criterion. In fact, it is nothing but a ‘bait and switch‘ salesmen’s trick.
- Holistic: This is a little trick that IM proponents love. With it, they imply that normal medicine is not holistic. However, this implication is demonstrably wrong. Any good medicine is holistic, and if a sector of healthcare fails to account for the whole person, we need to reform it. (Here are the conclusions of an editorial I published in 2007 entitled ‘Holistic heath care?‘: good health care is likely to be holistic but holistic health care, as it is marketed at present, is not necessarily good. The term ‘holistic’ may even be a ‘red herring’ which misleads patients. What matters most is whether or not any given approach optimally benefits the patient. This goal is best achieved with effective and safe interventions administered humanely — regardless of what label we put on them.) Creating a branch of medicine that, like IM, pretends to have a monopoly on holism is grossly misleading and can only hinder this process.
- Patient-centred: This is the same mean little trick in a different guise. They imply that conventional medicine is not patient-centred. Yet, all good medicine is, of course, patient-centred. To imply otherwise is just daft.
- Consideration of the patient’s physical and psychological wellbeing and treating the whole person rather than just the disease: Same trick yet again! The implication is that physical and psychological wellbeing and the whole person are not all that relevant in conventional medicine where only disease labels are being treated.
Altogether, this definition of IM is unworthy of anyone with the slightest ability to think critically. I find it much worse than the latest US definition (which already is fairly awful). In fact, it turns out to be a poorly disguised bonanza of strawman fallacies combined with ‘bait and switch’ deception.
How can this be?
How can a professional organisation engage in such mean trickery?
Perhaps a look at the list of speakers will go some way towards answering the question. Have a good look, you might recognize many individuals as members of our ALTERNATIVE MEDICINE HALL OF FAME.
Registration costs £ 249 (standard rate)
Perhaps I should also mention at least 4 of the many commercial sponsors of the conference:
The British Royal Family have been proponents of homeopathy for generations. Homeopathy was originally introduced into the UK by Frederic Hervey Foster Quin who, as a young physician, had visited Hahnemann in Koethen, Germany. Quin was soon fully converted to homeopathy and returned to England. Being well-connected to the European aristocracy, he managed to attract many influential personalities to homeopathy. In 1844, he founded the British Homeopathic Society and, in 1850, he opened the predecessor of the Royal London Homeopathic Hospital which is today called the Royal London Hospital for Integrated Medicine.
Our Queen has many times been reported to swear by her homeopathic remedies. Some went as far as claiming her good health in old age must be due to her using homeopathy to keep well. Here is just one example from ‘THE OFFICIAL HOMEOPATHY RESOURCE’ of 2016:
On her 90th birthday, the London Weekly News reports that in spite of criticism the Queen has used homeopathy all her life and has remarkable good health. In fact, many generations of the Royal family have used homeopathy
For as The Queen marks her 90th birthday on April 21, that she has reached such an excellent age is largely due to her lifelong trust in homeopathy. Everywhere that Her Majesty goes she is accompanied by a small case of special cures and tinctures and, although doctors no not care to admit it, it is because of her herbal little helpers that she rarely gets a cold or any other sort of complaint.
Empiricists would argue that as both The Queen and the late Queen Mother have been avid fans of homeopathy and as The Queen Mum died at the age of 101, the glaring probability that it works seems to be rather evident.
Sadly, her good health cannot last forever, and we have all seen recent reports of her being unwell, spending one night in hospital, and announcing the cancellation of all her engagements during the next two weeks resting on doctors’ orders.
Peter Fisher was her homeopath, but he tragically died three years ago. Did the Queen appoint another homeopath to look after her? Did she go into the Royal London Hospital for Integrated Medicine when she was ill? Was she reported to be taking homeopathic remedies during her recovery? The answer to all those questions seems to be NO.
What does that tell us?
I have often observed that our Royals use homeopathy while they are well and conventional medicine when they are ill. The Queen might have followed this strategy too. But not appointing a successor to Peter Fisher suggests something quite different. Does it indicate, I ask myself, that the Queen has recently had the occasion to look at the evidence and concluded – as most intelligent people did some time ago – that homeopathy does not work beyond placebo?
I certainly hope so, not least because refusing to rely on homeopathy would significantly increase her chances of remaining our Queen for some time to come.
The Austrian Health Insurance Fund is the largest social health insurance in Austria. Currently, about 82 percent of the people living in our country are insured with the ÖGK – that is 7.2 million insured persons. The ÖGK was created on 01.01.2020 through the merger of the nine former regional health insurance funds.
I was alerted to the following announcement by the Austrian Health Insurance Fund (my translation):
The Austrian Health Insurance Fund (ÖGK) ensures comprehensive medical care. However, medical services that do not treat an illness or contribute to preventive health care have to be paid for by the insured persons themselves
In the following cases, you have to pay for the services yourself, even if you use a panel doctor (Vertrauensarzt):
- Sports or driving licence examinations
- Exemptions from gym classes
- Vaccinations (if they are not medical treatment)
- Second medical opinions
- Requests for nursing leave
- Employment examinations on commencement of employment
- Treatments for which there is no scientific medical evidence of effectiveness (e.g. homeopathy)
- Purely cosmetic treatments
- Examinations for the clarification of claims for disability, occupational incapacity, incapacity to work.
The term HOMEOPATHY was not highlighted in the original. As it is, however, of particular interest to the discussions on this blog, I took the liberty of doing so.
The writing for homeopathy had been on the wall for some time in Austria- to be exact, since 1819!
This is when his majesty, the emperor Franz 2nd, issued the above decree strictly forbidding Hahnemann’s method.
Prohibition of Hahnemann’s healing method
His Majesty, by the highest resolution of October 13, 1819, decreed: Doctor Hahnemann’s homeopathic method of treatment is to be generally and strictly prohibited.
Court Chancellery Decree of 21 October 1819, to all State Offices
- it is being marketed very aggressively,
- it is the “world’s 1st super supplement”,
- we have on this blog a long debate with one of the experts responsible for Lyma.
On 18 March 2019, Paul Clayton, a clinical pharmacologist employed by the firm, stated the following about Lyma: you will realise that all the actives bar one (the ashwagandha) are food derivates / extracts. I take this to mean that, except for ashwagandha, all the ingredients of Lyma ought to be inherently safe. If we accept this for a moment (even though I am not sure that it is entirely correct), it means that ashwagandha determines the safety of Lyma more than any of the other ingredients. Paul Clayton also assured us that Lyma is totally safe, meaning that no serious concerns about ashwagandha’s safety have been reported.
Sadly, this does not seem to be quite true. There have been several reports of liver injury after the consumption of the herbal remedy. Here is another article that is not Medline-listed: Inagaki K, Mori N, Honda Y, Takaki S, Tsuji K, Chayama K. A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by Ashwagandha. Kanzo 2017; 58: 448-54. (20 year old man developed jaundice a month after increasing the dose of ashwagandha [bilirubin 20.7 mg/dL, ALT 94 U/L, Alk P 343 U/L, INR 1.02], jaundice persisting for more than 2 months, but ultimately resolving).
Perhaps the most concerning paper is this latest article:
Background & aims: Ashwagandha (Withania somnifera) is widely used in Indian Ayurvedic medicine. Several dietary supplements containing ashwagandha are marketed in the US and Europe, but only one case of drug-induced liver injury (DILI) due to ashwagandha has been published. The aim of this case series was to describe the clinical phenotype of suspected ashwagandha-induced liver injury.
Methods: Five cases of liver injury attributed to ashwagandha-containing supplements were identified; three were collected in Iceland during 2017-2018 and two from the Drug-Induced Liver Injury Network (DILIN) in 2016. Other causes for liver injury were excluded. Causality was assessed using the DILIN structured expert opinion causality approach.
Results: Among the five patients, three were males; mean age was 43 years (range 21-62). All patients developed jaundice and symptoms such as nausea, lethargy, pruritus and abdominal discomfort after a latency of 2-12 weeks. Liver injury was cholestatic or mixed (R ratios 1.4-3.3). Pruritus and hyperbilirubinaemia were prolonged (5-20 weeks). No patient developed hepatic failure. Liver tests normalized within 1-5 months in four patients. One patient was lost to follow-up. One biopsy was performed, showing acute cholestatic hepatitis. Chemical analysis confirmed ashwagandha in available supplements; no other toxic compounds were identified. No patient was taking potentially hepatotoxic prescription medications, although four were consuming additional supplements, and in one case, rhodiola was a possible causative agent along with ashwagandha.
Conclusions: These cases illustrate the hepatotoxic potential of ashwagandha. Liver injury is typically cholestatic or mixed with severe jaundice and pruritus, but self-limited with liver tests normalizing in 1-5 months.
In the lengthy exchanges between Paul Clayton and others on my blog – truly worth reading! – Paul assured us all that he is a serious scientist who would not mislead the consumer. At the time, he might not have been aware of the above-mentioned reports (the most recent of the above-mentioned papers was published in April 2020). Today, however, he must know of these concerns. Therefore, we can soon expect some serious measures from him and his employers, the firm that manufactures/sells Lyma.
I wonder what they will do. As far as I can see, it will have to be the voluntary withdrawal of Lyma from the market or, at the very least, the inclusion of a warning in all their materials:
“This product may cause severe liver damage”.
In so-called alternative medicine (SCAM), vitamin D is often recommended for a range of indications, including cancer prevention. Observational studies did indeed suggest that low vitamin D status may be a risk factor for cancer. On the basis of such evidence, a team of researchers sought to determine if vitamin D supplementation lowers the risk of cancer and precancers.
The Vitamin D and type 2 diabetes (D2d) cancer outcomes study (D2dCA) is an ancillary study to the D2d study, which was conducted at 22 academic medical centers in the United States. Participants had prediabetes and overweight/obesity and were free of cancer for the previous 5 years. Participants were randomized to receive vitamin D3 4000 IU daily or placebo. At scheduled study visits (4 times/year), cancer and precancer events were identified by questionnaires. Clinical data were collected and adjudicated for all reported events. Cox proportional hazard models compared the hazard ratio (HR) of incident cancers and precancers between groups.
Over a median follow-up period of 2.9 years, among 2385 participants (mean age 60 years and 25-hydroxyvitamin D 28 ng/mL), there were 89 cases of cancer. The hazard ratio (HR) of incident cancer for vitamin D vs placebo was 1.07 (95% CI 0.70, 1.62). Of 241 participants with incident precancers, 239 had colorectal adenomatous polyps. The HR for colorectal polyps for vitamin D vs placebo was 0.83 (95% CI 0.64, 1.07).
The authors concluded that, in the D2d population of participants with prediabetes and overweight/obesity, not selected for vitamin D insufficiency, vitamin D supplementation did not have a significant effect on risk of incident cancer or colorectal polyps.
For some reason, the discussions about the value of vitamin D for any condition tend to be dominated by emotion rather than evidence. This is particularly true in the realm of SCAM. The trial is a significant step forward. It is rigorous and generates clear findings. Let’s hope it will contribute to a more rational debate about the value of vitamin D in cancer prevention.
The secret is simple, and it is for sale. The advertising could not be clearer:
“Get ready for some good lovin’ because more blood to your bits means better stimulation to your love organ, which may improve fertility and give you a boost to your libido.”
The supplement that can achieve all this for you is called ‘Nitro Wood‘. It contains the following ingredients:
PINE BARK + BEETROOT + CINNAMON + GRAPE SEED EXTRACT + GARLIC EXTRACT + CAYENNE PEPPER
- Promotes Nitric Oxide Production Studies suggest that almost half the cases of sexual dysfunction in men are from lack of nitric oxide. This explosive blend naturally triggers the best kind of nitric oxide production — your own body’s.
- Lowers Blood Pressure Healthy blood vessels significantly lower your risks of heart disease and stroke. This combination of superfood extracts is high in nitrates, which is nature’s way of keeping your blood pressure in check.
Improves Physical Performance You’ll notice a vast improvement in your physical activity and endurance, whether at the gym or in the bedroom. Whatever the playground, you’ll be knocking it out of the park!
Nitro Wood contains key nutrients that are proven to support healthy blood flow, improving your overall wellness, energy levels and performance in the gym — and in the bedroom (if you know what we mean 😉
Cedars-Sinai Cardiologist Dr. David M. Filsoof, M.D.
And at an ‘auto subscription’ prize of US$ 34.39 for 30 servings, this seems a bargain too good to miss. There is, as far as I can see, just one tiny little snag: I failed to find anything that looks remotely like evidence to suggest that ‘Nitro Wood’ has any effect whatsoever.
So, in case you are disappointed by this product and also prefer something that is ‘super safe’, how about this gadget?
Doubting your capability in bed? We got you! We are happy to offer you a product that can make you last long in bed while providing the maximum performance! Introducing the 4000ions HardSteel AlphaMaleMagnetic Bracelet
This STYLISH BRACELET is POWERED by a BUILT-IN INFRARED that has a BIO-ACT TECHNOLOGY that DELIVERS the fir (far-infrared) energy into a nano structure that PENETRATES DEEPLY in to the human skin and provides the following benefits: Reduces Inflammation, Strengthens Heart Health, Aids Digestion, Lowers Blood Pressure, Detoxify Body, Relieves Stress and Boosts Immune System.
Please note how almost all the buzz-words of so-called alternative medicine are elegantly put to their strongest advantage:
- immune system
The ‘4000ions HardSteel AlphaMaleMagnetic Bracelet’ has the additional advantage of being more economical. It costs just Euro 10.26!
Alas, the gadget has the same drawback as the ‘Nitro Wood’ supplement: there is not a jot of evidence to suggest that it helps anyone else than the manufacturer.
Increased intestinal permeability, also often called leaky gut syndrome, has been popularized by some health practitioners, mainly those of so-called alternative medicine (SCAM). There is insufficient evidence to support its existence and the claim that SCAMs are effective treatments of it is unsubstantiated.
This study aims to describe the health-seeking behavior of Australian adults with suspected increased intestinal permeability (IP). A cross-sectional survey was conducted of 589 Australian adults who have been diagnosed with IP or have suspected (undiagnosed) IP.
The majority (56.2%) of participants with suspected IP reported self-diagnosing their condition, with the majority (56.7%) of these participants preferring to be assessed using an accurate method by a general practitioner or naturopath. On average, Australian adults with suspected IP spent 11.1 (95% CI: 9.5, 12.8) years between first suspecting IP and receiving a formal diagnosis. Over the previous 12 months, participants spent an average of $699 on consultation fees, $2176 on dietary supplements for the treatment of IP, and an average of $287 on the assessment of IP. Furthermore, participants who find it difficult to live on their available household income spent significantly more (mean=$2963) on dietary supplements compared to participants who find it easy to live on their available household income ($1918) (p=0.015).
In terms of the preferred method of treating IP, participants ‘strongly prefer’ the use of dietary products (n=392, 82.2%), followed by lifestyle habits (n=357, 76.5%), and dietary supplements (n=324, 68.6%). On the contrary, 82.8% (n=351) of participants ‘slightly prefer’ the use of medications to treat IP, representing the least preferred method of IP treatment.
The authors concluded that the majority of participants experienced a considerable length of time between first suspecting IP and receiving a diagnosis of IP. The out-of-pocket expenditure associated with the management of IP suggests a financial burden for people with suspected IP. The results of this study provide novel patient-centred considerations that can be used to inform a clinical practice guideline for the management of IP.
I would, however, draw a very different conclusion from these data: patients who think they suffer from IP often fall into the hands of SCAM practitioners who assure them to have a non-existing disease and relieve them of their money by treating them with bogus SCAM.
Gua sha, sometimes referred to as “scraping”, “spooning” or “coining”, is a traditional Chinese treatment that has also been adopted in several other Asian countries. It has long been popular in Vietnam and is now also becoming
well-known in the West. The treatment consists of scraping the skin with a smooth edge placed against the pre-oiled skin surface, pressed down firmly, and then moved downwards along muscles or meridians, the assumed ‘energy’ channels of traditional Chinese medicine. According to its proponents, gua sha stimulates the flow of the vital energy ‘chi’ and releases unhealthy bodily matter from blood stasis within sored, tired, stiff or injured areas.
Gua sha is a traditional healing technique that aims to create petechiae on the skin for a believed therapeutic benefit. Natural healings are mostly based on repeated observations and anecdotal information. Hypothetical model for healing does not always fit the modern understanding. Yet, the mechanisms underlying Gua Sha have not been empirically established. Contemporary scientific research can now explain some events of traditional therapies that were once a mystery. It is assumed that Gua Sha therapy can serve as a mechanical signal to enhance the immune surveillance function of the skin during the natural resolving of the petechiae, through which scraping may result in therapeutic benefits. The current review, without judging the past hypothetical model, attempts to interpret the experience of the ancient healings in terms of contemporary views and concepts.
The authors conclude that this narrative review draws up a survey of scientific sources on an ancient healing, scraping therapy. It is hypothesized that the skin, the nervous system and immune system interact with one another to generate a cascade of physiological responses to the scraping, through which scraping may result in therapeutic benefits. Within the scope and limitations of this review, only a brief overview could be given of the potential relationship between the observed outcomes and scraping therapy. Implementing effective traditional healings within health systems will require appropriate knowledge translations and future prospective studies.
And they add the following ket points:
- The observed therapeutic effects following scraping therapy may be a physiological response to the minor bruising.
- Scraping is assumed to be a mechanical signal to elicit the immune function of the skin.
- Through natural resolving of the scraping marks (petechiae) a cascade of physiological responses are generated.
- Counterirritation and placebo effect can also contribute to positive effects for symptom relief.
I think that this paper is a good example for highlighting a common misunderstanding in so-called alternative medicine (SCAM): the confusion about how and whether any given therapy might work.
It is in my view utterly irrelevant, to consider or investigate the mechanisms of action of a SCAM that has not been proven to be an effective treatment of a disease or symptom. Such an approach can only lead to confusion about the value of the SCAM in question. In the present case, it makes gua sha look almost like a reasonable therapy, and consumers who read the paper might conclude that gua sha is worth trying.
A deliberately exaggerated example might make this clearer: If I fall down the staircase, a multitude of physiological effects of the fall could easily be verified on my body. Yet, nobody would claim that throwing patients down the stairs is of therapeutic value. Likewise, the forceful scratching of the skin is bound to have all sorts of physiological effects. These are, however, totally irrelevant until someone has shown that the procedure also has therapeutic value.
To put it bluntly: who cares how a SCAM works when it is unproven that it works?
Muscular dystrophies are a rare, severe, and genetically inherited disorders characterized by progressive loss of muscle fibers, leading to muscle weakness. The current treatment includes the use of steroids to slow muscle deterioration by dampening the inflammatory response. Chinese herbal medicine (CHM) has been offered as adjunctive therapy in Taiwan’s medical healthcare plan, making it possible to track CHM usage in patients with muscular dystrophies. This investigation explored the long-term effects of CHM use on the overall mortality of patients with muscular dystrophies.
A total of 581 patients with muscular dystrophies were identified from the database of Registry for Catastrophic Illness Patients in Taiwan. Among them, 80 and 201 patients were CHM users and non-CHM users, respectively. Compared to non-CHM users, there were more female patients, more comorbidities, including chronic pulmonary disease and peptic ulcer disease in the CHM user group. After adjusting for age, sex, use of CHM, and comorbidities, patients with prednisolone usage exhibited a lower risk of overall mortality than those who did not use prednisolone. CHM users showed a lower risk of overall mortality after adjusting for age, sex, prednisolone use, and comorbidities. The cumulative incidence of the overall survival was significantly higher in CHM users. One main CHM cluster was commonly used to treat patients with muscular dystrophies; it included Yin-Qiao-San, Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Zhi-Ke (Citrus aurantium L.), Yu-Xing-Cao (Houttuynia cordata Thunb.), Che-Qian-Zi (Plantago asiatica L.), and Da-Huang (Rheum palmatum L.).
The authors concluded that the data suggest that adjunctive therapy with CHM may help to reduce the overall mortality among patients with muscular dystrophies. The identification of the CHM cluster allows us to narrow down the key active compounds and may enable future therapeutic developments and clinical trial designs to improve overall survival in these patients.
What the authors have shown is a CORRELATION, and from that, they draw conclusions implying CAUSATION. This is such a fundamental error that one has to wonder why a respected journal let it go past.
A likely causative explanation of the findings is that the CHM group of patients differed in respect to features that the statistical evaluations could not control for. Statisticians can never control for factors that have not been measured and are thus unknown. A possibility in the present case is that these patients had adopted a different lifestyle together with employing CHM which, in turn, resulted in a longer survival.
As discussed regularly on this blog, there is plenty of evidence to show that many chiropractors, homeopaths, and naturopaths discourage their patients from getting vaccinated. Now, a further investigation from the US seems to confirm these findings.
The data from the 2017 National Health Interview Survey (NHIS; n = 26,742; response rate 80.7%) was used for this purpose. Prevalences of flu vaccination, consultations with SCAM practitioners in the past 12 months, and their potential interactions were examined.
A total of 42.7% of participants had received the flu vaccination in the past 12 months, 32.4% had seen one or more SCAM practitioners. Users of any type of SCAM were as likely as non-users to have received a flu vaccination (44.8% users versus 41.7% non-users; p = 0,862; adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI] = 0.95-1.07).
Regarding specific SCAMs, individuals consulting with
- naturopaths (p < 0.001; AOR = 0.67, 95 %CI = 0.54-0.82),
- homeopaths (p < 0.001; AOR = 0.55; 95 %CI = 0.44-0.69),
- chiropractors (p = 0.016; AOR = 0.9, 95 %CI = 0.83-0.98)
were less likely, while other SCAM approaches showed no significant association with flu vaccination behavior. Independent predictors for a flu shot were prior diabetes, cancer, current asthma, kidney disease, overweight and current pregnancy. As well, higher educational level, age, ethnicity, health insurance coverage, and having seen a general physician or medical specialist in the past 12 months were also associated with a higher vaccination rate.
The authors concluded that SCAM users were equally likely to receive an influenza vaccination compared with non-users. Different complementary therapies showed varied associations with vaccination behavior. Further analyses may be needed to distinguish influencing factors among patients’ vaccination behavior.
This investigation confirms the prevalent anti-vax stance within chiropractic, homeopathy, and naturopathy. The effect is strongest by far with homeopaths. Nothing new! We knew this for a very long time. The question is WHAT ARE WE DOING ABOUT IT? Or more specifically, are the professional organizations of these SCAM professions finally going to take any actions against even the most rabid anti-vaxxers in their midst?
And the answer?
You guessed it: NO!
And the irony of all this must not get lost here: chiropractors, homeopaths, naturopaths, and their respective organizations all pride themselves regularly that they attribute particular importance to disease prevention.