When people ask me “What is naturopathy?” I have never been able to give a good concise answer. I can confidently explain what acupuncture, chiropractic and homeopathy are all about, but naturopathy has eluded me. I have finally realized that it’s not my fault. The whole concept is so ill-conceived and poorly defined that it defies grasping with a single definition. It is so nebulous that it allows its practitioners to believe and do almost anything. It is loosely unified by an emphasis on natural treatments that allow the body to heal itself, and an avoidance of drugs and surgery.
Naturopathy grew out of a 19th century European tradition of spas, water cures, and nature cures. Father Sebastian Kniepp believed he had cured himself of tuberculosis by bathing in the Danube River. His beliefs were popularized in the US by Benedict Lust (although Lust did not attempt to bring the Danube to America). Before establishing his own school of naturopathy, Lust studied homeopathy, osteopathy, and Ayurveda as well as conventional medicine. His approach included massage, hydrotherapy, herbal medicine, avoidance of caffeine and alcohol, and nude sun bathing. He was arrested 19 times during his career.
Naturopathy arose in a pre-scientific environment, then lost popularity as scientific medicine developed effective treatments during the 20th century. It had a resurgence in the 1970s as part of the trend of so-called “alternative” medicine. It is currently taught in 6 schools in the US and licensed in 15 states. A few states even allow naturopaths to perform minor surgery and to prescribe drugs. On the other hand, laws in South Carolina and Tennessee specifically prohibit the practice of naturopathy.
Naturopathic education is claimed to be similar to medical school education, but it is seriously lacking in one area: naturopaths do not have the in-hospital training with really sick patients that MDs get in their residency training programs. Any doctor will tell you that book-learning and medical school classes are not enough. They merely provide a foundation; it is the experience of taking responsibility for patients during the residency programs that makes us into real doctors. It’s hard to imagine how naturopaths could be effective doctors without having had the experience of treating seriously ill patients. How could they develop the judgment needed to recognize emergencies requiring surgery or hospitalization? In one study, only 40% of naturopaths recognized that a fever in a 2 week old infant is an emergency requiring hospitalization.
Kimball Atwood has pointed out that “regardless of what basic sciences are taught or who teaches them, the students are also taught that homeopathy is valid, that dissolved oxygen can be absorbed through the skin in appreciable quantities, that sugar in the diet translates to sugar in the ear, that Goldenseal cures streptococcal pharyngitis, that wet compresses can abort an evolving stroke, that swallowed whole enzymes traverse the gut and home in on arthritic joints, that the iris contains a homunculus that is the key to diagnosis of disorders throughout the body, that “craniosacral rhythms” exist, and all the rest.” 
The basic framework of naturopathy is philosophical rather than scientific. It involves a vitalistic belief that a life force (analogous to chiropractic’s Innate and Traditional Chinese Medicine’s qi) makes the body capable of healing itself if supported by good health practices such as diet, exercise, and natural remedies. Naturopathy claims to be holistic, to treat the whole patient rather than the disease. It holds that “natural” remedies are good and that surgery and prescription drugs are bad; but strangely enough, naturopaths have recently sought prescribing privileges.
The six basic tenets of naturopathy are
- First do no harm.
- Physician as teacher.
- Treat the whole person.
- Healing power of nature.
- Treat the cause.
Naturopathy can hardly claim to own these principles. They are the same principles of good medicine that I was taught in medical school. Primum non nocere has been a foundational principle of all medicine since the ancient Greeks. Physicians have always been teachers: they have specialist knowledge that they impart to patients, and good doctors act as the patient’s partner in decision-making rather than unilaterally dictating a course of action. We are taught in medical school to look at the whole person: not just a body with disease, but an individual with a history, a psychology, belief systems, a family, a job, a lifestyle, finances, an environment, and other factors that must be considered to achieve the best health outcome. We all know that prevention is the best cure. Our treatments don’t heal: the body heals itself; at best, our treatments can only facilitate that healing. All of medicine is directed at understanding the causes of disease so we can treat effectively; the idea that conventional medicine only treats symptoms rather than underlying causes is a vile lie perpetrated by the enemies of scientific medicine. If you are coughing and have a fever, we don’t just treat your symptoms with cough medicine and aspirin: we take an x-ray, diagnose pneumonia, figure out what specific bacterium is responsible, and choose an antibiotic effective against it. Naturopaths might argue that we have not specifically treated whatever allowed the individual to get the infection when he did. But they haven’t shown that they understand that process any better than we do. They invoke simplistic and unproven causes like toxins, allergies, yeast, poor diet, and imbalances of qi.
So despite their claims to uniqueness, naturopaths are actually only aspiring to do what good doctors everywhere aspire to do. OK, so how are naturopathic doctors actually different from medical doctors? In essence, they throw science out the window.
Stephen Barrett, founder of Quackwatch, has characterized the average naturopath as “a muddlehead who combines commonsense health and nutrition measures and rational use of a few herbs with a huge variety of unscientific practices and anti-medical double-talk.” They choose from a smorgasbord of implausible, pseudoscientific, untested, disproven, unethical, and dangerous treatment methods including “colonic irrigation (enemas) and fasting for ‘detoxification,’ hydrotherapy (wrapping part or all of the body in wet towels), homeopathy, acupuncture, chiropractic manipulation, aromatherapy, arduous dietary regimens, intravenous vitamin C, hydrogen peroxide and ozone, whole enzyme pills, herbs, desiccated animal organs, and other ‘natural remedies.’” As early quackbuster Morris Fishbein said, “…the modern naturopath embraces every form of healing that offers opportunity for exploitation.” Much of what they recommend is outright quackery.
They sell natural medicines to their clients at a profit; this practice is formally approved by their professional organization. They encourage home births: they are not trained to do surgery, so what happens if their patient develops an emergency at home that requires a life-saving C-section? They discourage fluoridation of water supplies. Only 20% of them support vaccination. A recent study showed that patients who saw naturopaths were significantly less likely to have received vaccines; this reduces herd immunity in the community and puts us all at risk.
They use a number of nonstandard, implausible, and even disproven diagnostic methods. Iridology purports to diagnose by seeing every part of the body represented on the iris of the eye. Applied kinesiology is a bogus muscle testing technique where a patient holds a sealed vial containing an allergen and the practitioner diagnoses allergies by imagining that the patient’s muscle strength diminishes: it only “works” if practitioner and patient know what is in the vial. Hair is analyzed by unreliable techniques that allegedly find toxins and vitamin and mineral deficiencies. Biofeedback machines that measure electrical skin conductance are said to be able to diagnose all kinds of illness. Live blood cells are examined under a microscope and artifacts misinterpreted as signs of disease. Unvalidated Chinese techniques of pulse diagnosis and tongue diagnosis are used. Reflexology postulates a map of the body on the soles of the feet, with massage of small areas on the sole said to affect the health of distant organs.
Bastyr University, the premier naturopathic school, has an AIDS Research Center. It recommends that HIV-positive patients be treated with “St. John’s wort and garlic (both of which have been shown to reduce blood levels of highly active antiretroviral therapy agents), ‘acupuncture detoxification auricular program,’ whole-body hyperthermia, ‘adrenal glandular,’ homeopathy, ‘cranioelectrical stimulation,’ digestive enzymes, colloidal silver, and nearly 100 other dubious methods.”
Naturopathy is a bizarre, incoherent mixture of fact, fantasy and quackery. Different naturopaths can believe different things and practice in different ways; there is no generally accepted standard, and different hypotheses are embraced simultaneously even though they seem to contradict each other. There is no evidence that patients benefit from a naturopathic approach compared to a conventional medical approach. Just the opposite: there is evidence of harm. They reject many standard treatments for diseases and sometimes take patients off critically needed medications. Patients have died. In one recent case in Seattle, a young girl died of a severe asthma attack after a naturopath failed to do the necessary tests to determine the severity of the attack and treated her only with B-12, a tincture, and acupuncture.
Arnold Relman, editor emeritus of the New England Journal of Medicine, reviewed the major naturopathy textbook and found glaring omissions, facts that were inconsistent with other sources, and recommendations for ineffective and potentially harmful treatments. He concluded “Judging by the standards of practice presented in the Textbook, it seems clear that the risks to many sick patients seeking care from the average naturopathic practitioner would far outweigh any possible benefits.”
Naturopathy doesn’t make sense. The things naturopaths do that are good are not special, and the things they do that are special are not good.
This article was originally published as a SkepDoc column in Skeptic magazine.