Since my involvement with the 10:23 Campaign here in Ottawa in February 2011 (see our media coverage), I have had a Google Alert set up to notify me when the words “homeopathy” and “Ottawa” occur together in a news article. This alert has been blissfully silent… until today!
The article was entitled “Exploring the natural way to stay healthy” – inoffensive to begin with. The details concern the Pure Med Naturopathic Centre, an alternative medicine clinic in Vanier, Ottawa, which opened in 2007 and which has recently welcomed a new naturopathic doctor. For those of you who are wondering how a Naturopathic Doctor (ND) differs from a Doctor of Medicine (Medicinae Doctor, MD), the details are a bit hazy and currently in transition. The Naturopathy Act requires that, to practice in Ontario, NDs must have completed a course at one of seven institutions across North America (two in Canada). Note that the accrediting agency on which the Naturopathy Act relies, the Council for Naturopathic Medical Education (CNME), lost its recognition in the USA in 2001 due to violations of its standards, but was reinstated in 2003. There are a range of courses (many online only) that offer naturopathic education but these are worthless in terms of the ability to practice. The accredited courses are typically four years, like a North American medical degree. A comparison between the two methods (from the University of Washington’s MD degree and Bastyr University’s ND degree) is interesting and reveals an lack of training in systems-related courses (i.e. skin, urinary, respiratory, cardiovascular, gastrointestinal…). This is replaced by a greater emphasis on “clinical and modality training”, which we can take to mean training in the various branches of alternative medicine (“homeopathy”, “botanical medicine”, “naturopathic manipulation”, and hydrotherapy are listed in the Bastyr curriculum).
But enough about the generalities. What does the new ND say in the article?
She describes naturopathic medicine as “a herbal way to treat patients without filling their bodies with particles that can hurt them.”
The classic “naturopathy is natural and therefore good – conventional medicine is chemicals and therefore bad” argument (aka the “naturalistic fallacy“). Whatstheharm.net covers the fallacy that naturopathy and its associated modalities are harmless. Further, the side effects associated with conventional treatments are almost always identified and published prior to the release of the drug on to the market. The occasional harm done by conventional medicine is vastly outweighed by the almost-immeasurable benefits in terms of the number of lives saved and improved.
“To stay healthy, she advises residents that it’s much better to come see a naturopathic doctor for a remedy instead of purchasing a supplement from the pharmacy.”
If we assume that she is talking specifically about arthritis here (as she was earlier in the paragraph), there are 43 Cochrane Reviews of pharmacological interventions for rheumatoid arthritis – many of which show a significant benefit. If she is talking generally about the seedy world of supplements in general then I would be tempted to agree with her. Very few supplements have demonstrated benefits and those are usually only in a small number of cases (see Information is Beautiful‘s brilliantly beautiful review). Of course, better than either of those two options is to seek the advice of a medical doctor.
“You don’t know what is in those packages at the pharmacy, but with us, it’s all natural and it will help you faster,” she added.
Fear-mongering as well. Tsk tsk… “Those packages at the pharmacy” have ingredients lists in English and as many other languages as are necessary for the customers to understand them. Compare with the leading homeopathic flu “remedy”, Oscillococcinum, whose ingredients are written in Latin!!! A US Government report published in 2010 found not only that herbal supplements were given with incorrect (and sometimes dangerous) advice, but also that 37 out of 40 products that were tested contained trace amounts of at least one toxic chemical.
“At the clinic, there are different forms of treatments, such as: Pain management treatment, intravenous therapy, Bowen treatment, kinesio taping, cosmetic procedures, supportive cancer care, fertility and pregnancy support and acupuncture.”
OK, so this is the interesting bit: do any of these remedies have an evidence base? I’ll take them one at a time:
– Pain management treatment– the website provides more details of the methods used. I will cover the Bowen technique and kinesio taping below, but the site also mentions “mesotherapy” – a modality that I have not encountered before. Mesotherapy is largely a cosmetic procedure that has been developed as an alternative to cosmetic surgery. The idea is that small, shallow injections of cocktails of chemicals can work to reduce adipose (fat) tissues, thus making you thin. Apparently (as with so many alternative medicine fads) science has yet to catch up to the naturopaths so we really have no idea whether mesotherapy is either safe or effective (contrary to the claims of the PMNC website). In fact, a study published in 2008 stated that “The technique is shrouded in mystery and the controversy surrounding it pertains to its efficacy and potential adverse effects that are subject of much concern.”
– Intravenous therapy – the question is, “what are they injecting into people?” Alternative medicine believes that everything from superdoses of vitamin C to hydrogen peroxide (bleach) will cure what ails ya.
– Bowen treatment – this is a modality that I wasn’t familiar with. Apparently it is a new variant of chiropractic, like Correactology, that involves light massage of different muscle groups with a two minute pause between each group. Suffice it to say there is no scientific evidence for efficacy. I predict that if they conduct a clinical study it will have some benefit over no intervention but the nature of the physical contact will be irrelevant (“sham” Bowen treatment will have as much effect as the technique itself), just like Reiki.
– Kinesio taping – another new one for me (which PMNC spells incorrectly on their website’s home page menu…). The Wikipedia article on the generic range of therapies that use elastic tape to assist with muscular injuries and ailments is quite informative. It cites six studies, of which two found no benefit, two found some evidence of a benefit that might not be clinically meaningful, one found a benefit to some areas of motion but not others, while the final paper looked for and found benefits only to the shoulder. Not comprehensive, by any means.
– Cosmetic procedures – can’t blame them for cashing in on people’s insecurities… I’m not sure what procedures this covers, though.
– Supportive cancer care – this is an important factor to bear in mind. In the article, the new ND stated “If you go see your family doctor, they can usually have a fixed time of how long your visit will be but with visiting a naturopathic doctor, you can take all the time you need. The advantage of coming to see one of us is that we have a luxury time with patients, not like other doctors,” she said. “We usually take about an hour, to an hour and a half…” Indeed, the homeopathic consultation has been proposed (with good evidence to support that proposal) to provide all the benefits of homeopathy, with the drug itself being inert. Spending time with cancer patients is an important service, though. It is worth bearing in mind that a number of other organisations also offer this service.
– Fertility and pregnancy support – again, it is a valuable service.
– Acupuncture – finishing on a high in this list… There are 337 Cochrane Reviews on the efficacy of acupuncture. Basically, the research that has been done shows that there are systematic biases in studies from different countries, better studies yield more negative results, and “real” acupuncture is no better than “sham” acupuncture.
In summary, aside from the counselling (which is offered by a number of other organisations) the Pure Med Naturopathic Centre appears to offer an interesting and potentially-dangerous array of unproven treatments (IV therapy, mesotherapy, homeopathy, Bowtech, kinesio taping…). These are marketed on the (false) basis that they are “natural” and better than “those packages at the pharmacy” that contain “particles that can hurt” the patient. The website does, however, have a link to the group’s blog which has a rather tasty-looking recipe for kale chips, so it may not be a complete loss…
4 thoughts on “Pure Med Naturopathic Centre, Ottawa: Logical fallacies and unproven treatments”
The time issue was the main reason I went with a midwife.Since midwives are regulated in Ontario and just as able to do the regular urine, blood pressure, yadda yadda tests as a nurse, I wasn’t sacrificing care. But then I get an hour long visit rather than 10-15 minutes during which I could talk about how I was feeling and all that. I figured that this might actually make it safer because it would make it easier to reveal symptoms that aren’t covered by the routine tests. And that’s what happened – I was feeling tired a lot and assumed it was because I was pregnant (does that, dontcha know), and I happened to mention it while just chatting with the midwife. She ordered an extra blood test done and it turned out that my iron was very low. That probably wouldn’t have come out in a regular OB visit.
On the herbal remedies, it’s horrendous how rife breastfeeding is with these things. When my milk was slow in coming in, everyone and their mother was trying to get me to drink fennel tea (which is too low a dose to actually do anything) and take fenugreek pills (which is of dubious value and, even if only labelled fenugreek, often have other herbs in them that can be harmful to nursing babies). And since no one takes this stuff to lactate unless they’ve just had a baby, when their milk eventually comes in, the herbs get the credit.
It is a major problem with our healthcare system in general. The fact that we know you can get an appreciable and statistically significant increase in the health of an entire population with only an additional investment of time, tea and cake, and yet we don’t act on it reflects badly on our healthcare system…
That seems to be a lot of the appeal of “alternative” practitioners — the time and the hand-holding.
I suspect a case could be made for the creation of a medical auxiliary discipline, maybe a nursing specialty, of Certified Hand-Holder and Cryable-Upon Shoulder (but we’d give it a hipper official title like “Wellness Counsellor”). Basically someone qualified to take history and symptoms, administer injections, give life-style advice and basic counselling, on a pay scale that allowed them to spend some quality time with the patient without bankrupting the system. By taking care of the routine cases they could even act as front-end filter for the higher-priced MD.
I agree, Eamon – the success rate for applicants to medical school in Canada is around 25% (http://www.afmc.ca/pdf/2008_admissions_book.pdf). With around 10,000 applicants per year, that means three times the number of doctors could be brought into the healthcare professions at a lower (but still important) clinical level.