If you’re a skeptic and supporter of science-based medicine (SBM), as I am, no doubt there are times when you ask yourself in exasperation, frustration, or curiosity just what the appeal of quackery is to so many people. Why do people fall for this stuff? you no doubt ask yourself at times. Certainly I do sometimes, and even though I know a lot about the cognitive shortcomings that we humans all share that lead to confirmation bias, confusing correlation with causation, mistaking placebo effects and regression to the mean for real therapeutic effects, and poor observational skills, sometimes these explanations don’t seem to be enough, even though I’ve exhibited some of them myself. Skepticism can reduce the effect of these cognitive quirks on our reasoning, but no human, no matter how steeped in science and skepticism, is completely immune to their effects. Even though I know this, I still sometimes puzzle over what the attraction of something as obviously pseudoscientific as homeopathy is.
That’s why I’m always grateful to anyone who can help me understand the reasons why human reasoning goes astray, even if she does so inadvertently. That person might not appreciate the not-so-Respectfully Insolent attention I bring upon her in learning more about the woo mindset, but I don’t really care. If you post something on the Internet, it’s fair game. You don’t see Orac whining when someone who doesn’t exactly agree with him decides to try to deconstruct one of his posts (good luck with that!), do you? Of course not. Leaving aside that digression, the latest
victim blogger who has inadvertently given me insight into the mind of woo blogs at—where else?—that wretched hive of scum and quackery, The Huffington Post. Meghan Pearson, a blogger who writes about vegan food and—surprise! surprise!—is also a reiki practitioner topics visited a naturopath and decided to blog about it, calling the end product, appropriately enough (for her) My Love Affair With Naturopathy (crossposted to the blog of the naturopath whom Pearson consulted). It is pretty much as bad as you might imagine from that title.
In this post, we learn that Pearson has a variety of health complaints, including a history of bulimia, chronic dry mouth, messed up menstrual cycles, and what she refers to as her “battered” immune system. We also learn that she likes things that are “natural,” whatever that means, her implication being that “natural” could somehow help her where she thinks “conventional” medicine has failed:
The thing is though, with all my concern and yearly check-ups, we never really “solved” a thing. Nope, my body is still quite out of whack; my monthly cycle is non-existent without the aid of oral contraceptives, I suffer from chronic dry mouth, and my blood pressure is continuously low. Visit after visit, my doctors of western medicine would listen to my concerns, conduct standard testing procedures, write me a prescription or a requisition for more invasive investigation, and then rush me out the door.
Which led Pearson to decide:
But I have decided that I want answers. Not just band-aid solutions, or easy fixes. With all my nutritional background and knowledge, and my keen interest in Eastern medicinal techniques, I now know that there are options, and that it is a lot simpler to work at preventing illness with lifestyle changes, than it is to try and “fix” disease once it is present.
This is, of course, the false dichotomy that truly drives me crazy. The implicit assumption behind such statements is that somehow naturopaths or other quacks are somehow more “natural” and “holistic” that doctors practicing science- and evidence-based medicine. Yet a good primary care doctor is a holistic doctor and will do what’s best for his patient regardless of whether it fits into the false “natural” paradigm peddled by alt-med practitioners. To put it bluntly, you don’t have to embrace “natural” quackery to be a holistic doctor, but that’s exactly what naturopaths want people to think: That they are more “natural” and “holistic” than those evil, money-obsessed “Western” doctors.
Enter Erin Wiley, the naturopath that Pearson ended up going to see. She practices at the Integrative Health Institute in Toronto. Naturopathy, as I’ve discussed before, is a grab bag consisting of a mix of treatments and ideas that range from pure quackery to ideas that are potentially reasonable but rendered much less so or completely unreasonable by being quackified. Examples of this latter category include nutrition and exercise, which, in naturopathy world tend to be related to science-based concepts of nutrition and exercise by coincidence only. True to this assessment, Wiley’s practice offers:
- Botanical Medicine
- Traditional Chinese Medicine (TCM) including acupuncture
- Strategic Nutritional Supplementation
- Lifestyle Counseling
As I said, a mixture of nonsense and seemingly reasonable treatments. For instance, homeopathy and detoxification are both pure quackery. Homeopathy, as we’ve discussed so many times before, consists of diluting remedies down to the point where there is not a single molecule of the original compound left. “Detoxification” involves doing all sorts of things to rid the body of vague “toxins” (which, oddly enough, are almost never identified or specified), including but not limited to chelation therapy, colon cleanses, liver flushes, Kinoki footpads, and “detox foot baths.” Much of traditional Chinese medicine, while it made sense in a prescientific belief system and in the context of prescientific concepts of disease and how the body works, is in essence vitalism. Speaking of traditional Chinese medicine, Wiley touts Chinese pulse and tongue diagnoses. Tongue diagnosis, as you might recall, involves looking at a person’s tongue and mapping different organs and parts of the body to it. As I’ve discussed before, real doctors do look at patients’ tongues in order to make diagnoses. You can actually tell a fair amount about a patient’s health by looking in their mouths. Hints in the diagnosis of vitamin deficiencies, amyloidosis, candidiasis, and many other things can be gleaned form taking a close look at the tongue.
In TCM, looking at the tongue can lead to fantastical diagnoses, such as Yin deficiency, heat in the heart, excess heat, deficient heat, blood deficiency, blood stagnation, qi deficiency (one wonders if qi deficiency results from the use of an alien healing machine), yang cold, yin cold, strong excess evil, or weak Zheng Qi. These are not real medical diagnoses, and one of the many reasons naturopaths can’t be considered in any way scientific is that TCM is part of its curriculum and used by nearly all naturopaths (well, that and homeopathy, which is just as bad, if not worse). Moreover, tongue diagnosis is such an integral part of TCM that it’s not an exaggeration to refer to it as being central to the entire system of medicine.
Pearson was also impressed that apparently this naturopath hooked her up to electrodes and measured a bunch of things about her body, which she described thusly:
We did my body composition test using a series of electrodes attached to a few points of my body, yet another new experience, but I won’t have those results until my next visit. Hopefully this can answer, among other things, the question as to whether or not my body is absorbing water into my organs as it should, and then we can figure out if and why I am so bloody thirsty all the time!
I wasn’t sure what this was. There are, after all, so many quack devices involving hooking up the patient to electrodes attached to a machine that goes ping, that gives all sorts of scientific-looking but meaningless results. Then I saw on the practice’s website just what it probably was that Wiley hooked Pearson up to: A “bioimpedance analysis” (BIA) machine. Now, BIA is a real machine that is sometimes used to estimate the proportion of body fat a patient has and fluid distribution. Another use of BIA is in measuring lymphedema after breast cancer surgery. If that were all that naturopaths used them for, then it might not be so bad, because BIA is a fairly standard way of measuring body fat. However, BIA is advertised for all sorts of conditions. I’ve seen claims that it can detect breast cancer before mammography, for instance. There is literature on using BIA to characterize cancer, but nothing that justifies claims that it can detect breast cancer so early. Is Wiley using BIA in a manner that measures what science-based medicine concludes that BIA can measure? Maybe. As always, the devil is in the details, and it seems highly unlikely that any BIA can determine whether Pearson is absorbing water into her organs as it should or that it could give any meaningful clues to help figure out why she is thirsty all the time. BIA might not be quackery when used properly, but the “used properly” part is very important. If all Wiley is doing with the results is trying to measure body fat distribution and water distribution, BIA is probably OK. If she’s making any claims more than a percent body fat and maybe a statement about edema, then she’s going too far. I can’t tell for sure which she is doing from Pearson’s account.
Perhaps one of the most amusing parts of the article is how blown away Pearson is that the naturopath actually did orthostatics on her. What I mean is that the naturopath took her blood pressure sitting down and standing up because her blood pressure is low (85/50), exulting that her regular GP had never done that before. Of course, if patients have orthostatic symptoms (getting light headed or feeling as though she is going to pass out when rising from a recumbent or sitting position to standing), it’s worthwhile to check for orthostatic hypotension. If she is asymptomatic, then most doctor’s wouldn’t worry much about a blood pressure of 85/50. It’s normal. Indeed, blood pressures that low tend to be associated with very healthy athletes. Orthostatic hypotension, of course, can be indicative a of a number of conditions, most commonly simply dehydration, but also certain neurological disorders, as a side effect of certain medications (such as antidepressants), or anything that can leave one dehydrated, such as, yes, bulimia. Then there’s Addison’s disease, which can also cause orthostatic hypotension and segues right into what Wiley thinks is wrong with Pearson:
So what conclusions did we come to? Well, I just may have a condition caused “adrenal fatigue” brought on by the high levels of stress I have been under over the course of the past few years. Apparently, my poor adrenal glands just aren’t functioning as they should, and in turn, a whole slew of other systems in my body are unhappy as well. This might explain the shortness of breath I have been having recently, my fluctuating energy levels, and dry mouth. I love that after just this one sit-down with me, Erin was able to recognize the wide array of symptoms I have, and focus them in on one specific possible cause. Next up: treatment!
I left that day armed with a ton of arsenal to put me on the path to recovery from my tired adrenals, including two recommended botanical supplements. Dr. Wiley also supplied me with a two-page “action plan” of sorts, to get me moving forward in improving my health in a holistic way. This print out serves as a guideline for a few very simple changes I can make to improve my digestive health, kidney function, endocrine balance, and general nutrition, all specific to my personal needs.
“Adrenal fatigue.” It had to be “adrenal fatigue.” It’s a favorite quack diagnosis (just Google it). It’s a wastebasket diagnosis for people with symptoms like this:
- You feel tired for no reason.
- You have trouble getting up in the morning, even when you go to bed at a reasonable hour.
- You are feeling rundown or overwhelmed.
- You have difficulty bouncing back from stress or illness.
- You crave salty and sweet snacks.
- You feel more awake, alert and energetic after 6PM than you do all day.
It become clear if you look at a typical diagnostic questionnaire for adrenal fatigue that it’s a dubious diagnosis. I took the questionnaire myself, and guess what? According to the questionnaire I have “moderate” adrenal fatigue myself! Get me to a naturopath, STAT, for some diet changes and supplements! Well, not so fast. The Hormone Foundation and The Endocrine Society both point out that adrenal fatigue is a bogus diagnosis. Adrenal insufficiency is a real diagnosis, and, yes, sometimes it’s not obvious to diagnose, leading to confusion, but there are definite diagnostic criteria to guide physicians in making it. But “adrenal fatigue” is a nonexistent diagnosis:
- “Adrenal fatigue” is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms.
- Adrenal insufficiency is a real disease diagnosed through blood tests.
- There is no test that can detect adrenal fatigue.
- Supplements and vitamins made to “treat” adrenal fatigue may not be safe. Taking these supplements when you don’t need them can cause your adrenal glands to stop working and may put your life in danger.
As I mentioned before, the symptoms of “adrenal fatigue” are nonspecific and could be indicative of many different conditions—or nothing at all. One of these days, I’ll have to delve more into “adrenal fatigue.” I can’t believe I haven’t done it before after all these years blogging. In the meantime, I’ll simply point out that, using the criteria I’ve been able to find on the web, I’d conclude that nearly everybody suffers from some degree of “adrenal fatigue”; that is, unless one doesn’t ever have stress, is always happy, and eats a raw vegan diet, and even then one might still have “mild” adrenal fatigue.
All of which brings us to why naturopaths seem so seductive. People with lots of nonspecific symptoms (sometimes called the “worried well”) often don’t like it when, after a real doctor tries his best to find out if there is anything wrong that he can treat, they are told that they have no specific disease or anything that can be cured with a pill or specific intervention. So, like Meghan Peary, they trot off in search of someone who can tell them what is wrong with them. Now, sometimes, the original doctor missed something and there really is something wrong with them that another doctor finds. More often, however, there is not. If such patients end up in a naturopath’s office, the naturopath will always have one or more of many nonspecific diagnoses like “adrenal fatigue” that have little or no basis in reality to give them. The patient now has an answer and a plan. She is happy. It doesn’t matter if that answer is pure pseudoscience and the plan is usually pure quackery or mixes some sensible suggestions with a whole lot of quackery. It’s an answer and a plan.