Sunday, April 12, 2009

Naturopathy, quackery, and medicine.

Deriving from discussions here. Incidentally, the below applies, mutatis mutandis, to chiropratic, homeopathy and acupuncture.

(1) If you're going to say that naturopaths are experts, then they have to have some actual knowledge. So what is their knowledge? Grant that it's not the same as medicine. So what is it? What do they know? Naturopathy is quackery, based on the only criterion that matters: it doesn't work. Medicine works.

(2) This epistemic point has nothing to do with any ethical point. Medicine is not undermined epistemically because some of its practitioners have ethical problems. (That would be like saying nuclear physics is undermined because some nuclear physicists developed nuclear weapons.) This is also irrelevant to the point at hand. Any problems with the pharmaceutical industry and its connections to medicine suggests a need for better regulation, not giving quacks more power.

(3) The claim that medicine focuses on treatment rather than prevention is both wrong and confused.

Prevention and treatment aren't independent of each other. Indeed, from a certain perspective, they're the same thing. Treatment can prevent recurrence; prevention can pre-empt the need for treatment. So, if you like, the distinction is between ex post -- treatment -- and ex ante -- prevention. That's why the claim is confused.

I can't recall ever going to a physician where I wasn't instructed in methods of improving diet, exercise, etc. in order to prevent disease and disability. I've also worked for physicians who habitually move between immediate intervention to cure disease or treat disability, and anticipatory interventions to ensure disease and disability do not occur (or worsen). My experience didn't strike me as particularly uncommon, so I take it that it generalizes. That's why the claim is wrong.

(4) Any claim that naturopathy somehow prevents disease/disability and makes people healthier is just not true. Naturopathy just doesn't do that. Naturopathy doesn't do anything; it's never stood up to a scientific test to show it has any measureable, objective effect whatsoever.

(5) If people want to waste their time and money on nonsense, that's their business. But I don't see any reason for the government to encourage it. I also see good reason against it, insofar as it might lead to broadly damaging consequences. It's one thing to allow people to do stupid things that only harm themselves; it's quite another to allow them to do stupid things that might harm everyone. (Again, compare to the issue of people refusing vaccinations for their children; past a certain point, that choice puts everyone at risk.)


Polinees said...

An interesting (though potentially irrelevant) sidebar would be a discussion of the atmosphere of a visit to one's medical doctor and one's naturapathic doctor. (As an additional sidebar, the term naturopathy is new to me. Yay for learning)

I've also argued that what the chiropractor, for example, does for you is not to provide a genuine medical solution to physical problem, but to give you a relaxing hour of massage and pain alleviation accompanied by relaxing music and smells. It's this forced hour of relaxation and low stress that probably helps the people visiting a chiropractor more than anything else.

Does this mean we're better off laying on a bed at home with quiet music and a scented candle while our partners give us back rubs? Almost certainly; we'd save money, at any rate. But let's be honest, how many people will genuinely schedule an hour of time a week to do something like that? Now if it's your scheduled 'doctor' appointment, maybe that's a totally different story.

Understand I detest this sort of homeopathic medicine. I'm merely stating that there is something to be gained from this different approach to medicine, to the idea that medicine should be low stress and relaxing instead of high stress and clinical. It would be practically impossible for a medical doctor to give a patient that kind of attention, so people turn to other sources.

ADHR said...

Granted, freely. But, as you point out, this isn't an exclusive benefit of homeopathy, chiropractic, naturopathy, acupuncture, etc. It's really an unintentioned consequence of all the messing around with potions, supplements, chi, subluxation, and so on. Which is the problem: if we acknowledge, in policy, that CAM can have these sorts of benefits, we have to do so in a way that doesn't legitimize the nonsensical aspects.

That said, why not just spend an hour at a decent spa? Given what naturopaths charge (usually over $100 an hour), that has to be a better option. (Or, for that matter, make it possible for people to do paid work for no more than 40 hours a week.)

Geekwad said...

Thanks for talking some sense. The initial response on the progressive logs was very depressing.

ADHR said...

There's something to be said for being suspicious of big institutions and conventional wisdom. When it goes over the edge into endorsing things that have no reasonable backing -- that's when I get off the bus.