Naturopathic distraction

This morning I saw a press release that said “Treatment by naturopathic doctors shows reduction in cardiovascular risk factors” based on a Canadian study. The skeptical bells went off in my head as I read it: this sure seems like a study designed to legitimize naturopathy by focusing on non-controversial practices. To add, 10 of 14 of the authors are from the Canadian College of Naturopathic Medicine. The full text is freely available here.

As a short summary of the study, Canada Post employees were screened and if they had the metabolic syndrome they were randomly assigned to either remain under the care of a primary care physician, or remain under primary care and add naturopathic treatment on top of that. The naturopathic group received 7 visits at naturopathic centers over 1 year.

Now, the Canadian College of Naturopathic Medicine themselves say naturopathic medicine includes traditional Chinese medicine (accupuncture, accupressure, massage, herbs etc), homeopathy, “physical medicine” (like chiropracticic, hydrotherapy, stretching), bontanical medicine, along with nutrition and lifestyle counseling. As poignantly stated by Timothy Caulfield and Christen Rachul, with the exception of evidence-based nutrition and lifestyle changes these therapies do “not support the proposition that naturopathic medicine is a science and evidence-based practice.” Their review of naturopathic practices in Canada found disturbing treatments such as colon cleansing, hair analysis, detoxification or biotherapeautic drainage, IV therapies, chelation therapy and many others lacking scientific substantiation, and these are used to treat a wide variety of diseases. The basis of naturopathy is a mystical and unscientific belief in “vitalism”, and the practice has homeopathy at the core, which is literally using water to treat disease.

In contrast, here is the “naturopathic” treatment used in the new study: content suppl 2013 04 29 cmaj.120567.DC1 cardio fritz 1 at.pdf

Though you could debate a couple of them, these are hardly controversial interventions!

Not surprisingly, in the 207 who completed the study, the proportion of individuals in the control (only primary care) group was 48% and in the naturopathic group it was 32%. Cardiovascular risk, as assessed by the Framingham risk score suggested a ~3% reduction in risk reduction in the naturopathic group. It is difficult to estimate if baseline differences had an influence on this as they don’t report p-values:

“The groups were similar at baseline, although the naturopathic group had a nonsignificantly higher prevalence of metabolic syndrome, larger waist and hip circumference, and greater weight. The naturopathic group reported significantly more weekly minutes of moderate exercise.”

They did not document treatments by the primary care physicians, and the added treatment may have influenced the primary care:

“naturopathic doctors measured risk factors 3 times during the course of the study, and participants were encouraged to report the results to their family physicians.”

And there was no blinding.

In an accompanying editorial, the journal’s (CMAJ) deputy editor, Matthew Stanbrook provides this warning ahead of inevitable naturopathic claims:

“We can learn nothing new from this trial about supplements or any other individual component of care, because the trial was not designed to allow their evaluation.”

Yet for some reason also writes:

“The results of Seely and colleagues provide proof of principle that some aspects of cardiovascular prevention could feasibly and effectively be delegated to naturopaths.”

In my opinion that is a dangerous path to suggest, as it is clear that the standardized and limited treatments in this study do not reflect real naturopathic practice.

It is good to have further support that diet and lifestyle changes can reduce cardiovascular risk. But this study was clearly designed to use non-controversial treatments to legitimize naturopathy. Diet and lifestyle counseling can be provided from dietitians, and their colleges and associations do not promote the non science-based treatments as do naturopaths.