The Trouble with Naturopaths

It’s a sickeningly regular occurrence lately to read articles about another baby damaged, or cancer patient mistreated, by an unregulated, irresponsible naturopath. All manner of natural therapies, therapists, healers and spruikers of wellness get bathed in the murky gloom of these stories. Recently the media has revisited the wellness warrior archetype in the form of Belle Gibson, creator of an uber successful health app, who turned out to be a fraudulent, pathological liar. That one hits a raw nerve for me for many reasons, what with our shared surname, and my role in the world of natural therapies, nutrition and cancer care. I am loathe to be associated with such charlatans, even writing this, I fear our fates could be entwined. But Belle is old news, well and truly hung out to dry, she’ll soon fade into obscurity to be replaced by another, similar saga.

It was only weeks ago that a so called medical herbalist was brought before a tribunal for treating someone with late stage bowel cancer, with predictably enough, disastrous effects. Investigations uncovered out of date herbs, poor record keeping and absolutely no knowledge of the limits of their scope of practice. Oh wait, that’s right, there is no set, officially sanctioned, regulatory body bound, scope of practice for herbalists, naturopaths or nutritionists. Because these are unprotected titles, anyone with a little chutz pah and marketing savvy can call themselves a ‘medical herbalist’, or ‘consulting naturopath’, ‘ND’, or ‘clinical nutritionist’.

Regulation, Professional Bodies and Educational Standards

The utter lack of regulation makes one wonder why students bother to undertake expensive (think $40K+) three, four or even five year courses to gain such qualifications as Bachelor of Health Science (Naturopathy), or even less valued and oxymoronic to some, a Bachelor of Health Science (Homoeopathy). Having taught in natural medicine colleges over 8 years, I know first hand how hard the students work, the sacrifices they, their parents and partners often make, in pursuit of a beautiful dream of helping people through providing holistic health care. These dedicated students suffer every time their future profession faces another scathing media report.

When they graduate with their shiny new Bachelor’s degree they can choose from a range of professional bodies, organisations sometimes run by education providers themselves to accredit their own students, and other times open to all kinds of modalities, so that a double major Health Sciences grad appears to the public to have the same level of membership as a short, ten or twelve week massage training graduate. In fact the public have no way of telling who is qualified and has membership of a body with standards, and who doesn’t. They are quite literally thrown to the wolves and the most charismatic tend to get the most clients, regardless of quality of service or professional standards.

There’s a blogger called Britt Hermes who writes The Naturopathic Diaries (naturopathicdiaries.com) and it’s a compelling read. Like me, she was whole hearted in her studies, diligent in her case studies and meticulous in student clinic. Yet not long after graduating she saw some things in the real world of commercial natural medicine that caused her to disown her own profession. Now she enjoys a popular following from the skeptics, including those who would have all natural medicine made illegal. There are plenty of scathing facebook groups such as the Blocked By Pete Evans page (yes, some of the members have quite literally been blocked from chef and paleo promoter Pete Evans’ page for questioning the dodgy advice he gives which basically equates to offering bone broth as a cure for everything from autism to menopause), who support one another in venting about the dangerous, pseudoscientific snake oil sellers. In many ways I agree with these skeptics, yet I retain hope for natural therapists. I’m not ready, like Britt Hermes, to throw in the towel on naturopathy, because I think there is a genuine possibility the current mess can be turned around. After all, things have dramatically changed in the 18 years since I began studying at Perth Academy of Natural Therapies.

As a student I received 100% on a Naturopathic Philosophy paper. I was so proud of this remarkable result I showed my older brother, who was then at UWA studying ancient history (there may be a genetic link to our possibly pointless educational pursuits but I digress). He hurt my feelings by noting the lack of references. It was pure conjecture, philosophical rambling and opinion, although admittedly well expressed. I was paying for an education in an established, at that time reputable, private college, where I didn’t need to provide references, not even to textbooks to get a top mark. Thankfully the educational standards have risen. When I graduated in 2000 with an Advanced Diploma of Applied Science, that was the top level available in face to face training, with some extension coursework available to upgrade to a Bachelor through distance education. Now the VET (vocational education and training) qualifications are being phased out, and all new grads are expected to undertake the Higher Education path to a Bachelor of Health Science degree. It’s the hangover from non-evidence based education in the past which is at the heart of many of the problems facing modern naturopathy.

Naturopathic Philosophy

If you accept that the body, given the right environment, can innately heal itself, does that extend to treating life limiting diseases naturopathically? Or is there a missing link in the philosophy, the part about treating the whole person perhaps? There’s a divide within naturopathy about whether we are in fact treating diseases, or people. I know for myself that my goal is to help people flourish. That means supporting them physically through nutrition and exercise, mentally and emotionally and in some cases spiritually to find meaning and purpose. I don’t profess to have the cure for cancer, or MS or dementia. And any practitioner who says they do is clearly selling you something. If we return to the naturopathic philosophy I was taught, it includes the following;

• First do no harm — which includes not delaying medical treatment, undermining other health professionals, creating fear, creating false hope or treating with harmful substances such as black salve for skin cancer.
• The healing power of nature — exposure to nature and the rhythms of the natural world can’t be underestimated. This is lifestyle medicine and the beneficial effects can largely be explained by the relaxation response. This is sometimes used to proclaim that nature holds the remedies for everything, but where nature ends and human creation begins is anyone’s guess. You could argue that laboratory created vitamin supplements are as far from nature as pharmaceutical drugs. Taken to it’s extreme this principle is used to decry anything ‘chemical’ and over value anything ‘natural’. Of course chemicals are natural, everything in the natural medicine tool kit that’s biologically active is working on biochemistry so the ‘natural is better than chemical’ argument falls down easily. However it’s fair to say that a less processed, closer to nature diet is probably health promoting, and the highly manufactured snack food will certainly do harm in large enough doses.
• Identify and treat the root cause — I wonder if this is always relevant. Sometimes symptom relief is enough to improve quality of life. Not everything can be ‘cured’ and not everyone has time or inclination to chase down the root cause. Certainly for cancer patients there’s a desire to know what caused the illness, and this knowledge may help to avoid future suffering. Eliminating the cause may be possible in the case of cigarette smoking, but as far as anyone knows, some cancers are just rotten luck. Dodgy practitioners can keep people enthralled for years trying to work out all their karmic issues from this life and others in a misguided attempt to ‘heal the cause’.
• Treat the whole person — to my mind this is the strength of a naturopathic approach. Done well, we can hear the full story and work with clients to strengthen their resilience on physical, mental and emotional levels. Most other practitioners have been trained to specialise in the body or the mind. Currently in the area of chronic pain there’s a fascinating intersection happening between psychology and physiotherapy. Yet in recent history, most patients would say they see one practitioner for physical ailments, and another for counselling or psychological support and never the twain shall meet. It’s refreshing and very much desired by clients for one practitioner to understand the whole person. This allows us to treat holistically. However it leaves us very much a generalist and makes cross referral to specialists very important. This is another area where naturopaths can sometimes fall down. Because we think we can cover many bases, we may neglect to send clients to relevant experts for specialised support. How can we possibly think we have learnt everything about the body, mind and spirit in three or four years of training? It causes natural therapists to over reach and this is potentially detrimental. Where would the place of a natural therapist be in a multi-disciplinary team I wonder? Perhaps to advise on complementary therapies and make suitable referrals.
• Physician as educator — another excellent principle in theory however as there’s no scope of practice, loose educational standards and a lot of beliefs and values as part of naturopathic training, what exactly are we passing on? It’s true that a significant part of a good consultation should be demystifying and explaining health concepts. More recent graduates are even encouraged to provide journal articles and links to evidence based information for clients to read. This is potentially a strength, but only if we educate accurately based on science, not if we are just teaching our clients what we believe or were taught and not keeping up with relevant research.
• The best cure is prevention — and naturopaths are largely excellent at preventive health through lifestyle coaching. However the majority of clients only go to see a practitioner for treatment of an ailment. Despite well marketed ‘wellness programs’, the out of pocket expense involved in private consultations means that preventive health is less commonly practiced than a remedy selling, treatment focused paradigm.

Is Evidence Based Complementary and Integrative Medicine (EBCIM) really a thing?

The short answer is yes. There’s some high quality evidence to support complementary practices like yoga and meditation. There’s some good epidemiological research to support balanced high vegetable and fruit intake diets. There are increasingly sound herbal medicine studies, and some fascinating many pronged designs combining conventional approaches with CIM.

In the field of cancer care the research shows that up to 70% of patients seek natural therapies. Only around 20% of them consult a practitioner. That means most are self prescribing and listening to lay advice or buying questionable products from Dr Google. Most are also not comfortable telling their oncologist or treatment team about their use of natural medicine. There are many reasons why a cancer patient might seek natural medicine, some sensible, some not, but they certainly deserve unbiased, reliable information so that they can have genuine informed consent.

What’s great about naturopathy

I think there’s a lot that’s great about naturopathy. We have a wonderful set of tools to work with the mind body connection, promote healthy, active lifestyles and provide client centred, kind supportive care. However we need to keep the dialogue between conventional medicine and complementary service providers open so that our clients can benefit.

I recently spoke to a group of oncologists, cancer nurses, radiation therapists and support staff at a cancer treatment centre here in Perth. When I showed them the plethora of evidence behind what we do, and assured them that risks were known and responsible care provided, there wasn’t even a murmur of skepticism. There was literally no resistance to providing newly diagnosed cancer patients with information to help them use natural remedies to manage common problems, and to increase their tolerance to treatment through stress management, exercise and nutrition.

For health professionals I’m passionate about increasing your awareness of natural therapies as an evidence based adjunct to your existing skills. Well trained naturopaths can make your job easier, just as I do for oncologists who don’t have time for long discussions about whether a herb is safe or suitable during treatment. If you could trust that a naturopath would give evidence based advice and keep you in the loop so that patients are safe, would you refer to them?

For people facing serious illness, I am passionate about you getting safe and responsible care in a warm and friendly environment. I hope you feel able to express all of your concerns, hopes and preferences to all of your health providers. I am happy to have open minded, non judgemental discussions that allow people to feel heard, supported and encouraged to find accurate information and navigate their way through the minefield of health information. A good naturopath will not be interested in hooking people into a relationship of dependency, or selling products. A great naturopath can be a source of steadiness, an educator who can help you make informed decisions, and give you more language to ask the right questions of all your health care team members.

I’m also passionate about helping naturopaths do well in practice. I know you studied hard and undertook this path with the very best intentions to share the beauty and insight of natural approaches in the best interests of a healthy community. I want to help you decrease the criticism and enter respectful dialogue with all areas of health and medicine. I want you to be able to stick your heads above the cawing mass of wellness advice on the internet and show that you are the best trained, best placed to support people to increase their wellbeing in sickness and in health. We can do that by pushing for a fair regulatory structure, and by working together to mentor practitioners who want to do the right thing and improve the reputation of our field.

Let’s create a health care system that benefits people facing serious illness, and prevents future illness as much as possible, by working together to support those who undertake, publish, translate and share research into the benefits and risks of natural therapies. Let’s engage the gatekeepers who may believe in holistic care yet feel frustrated by the woo, by opening up the lines of communication. Let’s put clients in the centre and deliver the very best in evidence based care from all modalities.