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Naturopathy: A Critical Analysis

Barry L. Beyerstein, PhD
Susan Downie

Naturopathy is the most eclectic of "alternative" practices. It has changed its methods in response to popular fads and beliefs. It practices no pool of consistent diagnostic or therapeutic methods. The most notable things that unite its practitioners are a penchant for magical thinking, a weak grasp of basic science, and a rejection of scientific biomedicine, which they refer to as "allopathy." Because naturopathy lacks a coherent rationale, patients can encounter anything from commonsense lifestyle advice -- eating a healthy diet, rest, exercise, and stress reduction -- to an array of scientifically implausible nostrums and gadgets [1].

If a glue binds the diverse and changing patchwork of naturopathic practices together, it is espousal of the teachings of the early nineteenth-century romantic movement known as Naturphilosophie. The central tenet of this movement affected the romantic poets and artists of the era and some noted scientists as well -- that there is a single unifying force underlying the entirety of nature, one that steers all of its parts into a harmonious and indivisible whole [2]. Much like the concept of "Qi" in Chinese philosophy and medicine, this mystical force is said to permeate all living things. Believers in Traditional Chinese Medicine (TCM) assert that imbalances in the flow of Qi are responsible for disease, fatigue, etc., and that that balance between yin and yang variants of Qi is essential to health. Acupuncture, Chinese herbs, etc., supposedly restore well-being by rebalancing the flow of this spiritual essence [3]. Naturopaths explain what they do by resorting to similar metaphorical usages of the terms "balance," "harmony," and "flow," which in the final analysis boil down to synonyms for "good" and have no science-based meaning. The similarities of their theories may explain why TCM is taught in naturopathic colleges.

A corollary of Naturphilosophie is that in order to comprehend nature one must experience it as a whole -- i.e., intuitively rather than objectively and analytically. Openness to one's subjective feelings is considered the most reliable means of revealing the workings of the natural world. Not surprisingly, then, naturopathy has been quick to ally itself with the "holistic health" movement. This emphasis on "holism" helps explain the apparent indifference and/or antipathy of most naturopaths to objective, scientific research.

Naturopathy views sickness as a generalized breakdown of the body in response to "unnatural" events in the enviroment that can be remedied by overall strengthening of the body's resistance. This clashes with scientific biomedicine's view that disease is a malfunction due to specific pathogens or processes that involve identifiable organ systems. Biomedicine tailors its treatments to the system and pathologic processes that are involved, whereas naturopathy claims to "treat the whole person."

Although naturopathy uses scientific terms and assumes some of the trappings of science, it exhibits more features of pseudoscience [4] and has magical and quasi-religious roots [5]. Its claim that healing stems from a supernatural "life force" is much like the abandoned principle from prescientific biology known as elan vitale [6]. Biologists once believed that a force that distinguished living from inanimate matter was derived from a cosmos whose natural order was governed by moral laws -- as opposed to the mechanistic ones of modern science. For proponents of naturopathy, "natural laws" are not generalizations from observation and experimentation, but seem to be the moralistic dictates of an anthropomorphic "Nature" -- usually capitalized to emphasize its purposeful, theistic properties. They also postulate that health is awarded or withdrawn in accordance with one's ability to maintain harmony and balance with the animistic, vital forces of the universe. In committing itself to vitalism, naturopathy puts bodily functions outside the realm of physics, chemistry, and physiology. This is apparent in the following excerpt from the writings of Harvey Diamond, an advocate of the "Natural Hygiene" movement: "The true cause of impaired health lies in our failure to comply with the laws and requirements of life. All health problems arise from the abuse of natural laws. . . . Living healthfully is not an art that we must learn, it is an instinctive way of life to which we must return!" [5:98]

From Where Did Naturopathic Dictates Arise?

Just as naturopathy reflects the nineteenth-century romanticism from which it sprang, the latter in turn bears the imprint of an older tradition of the ancient Greek mystery cults and the teachings of the pre-Socratic philosophers Heraclitus and Parmenedes [7]. Their descendants inspired the "counterculture" of the 1960s and 1970s with its passion for egalitarianism, naturalness, and the primitive, entwined in a narcissism that equates truth with emotion rather than reason [8]. At the same time, the humanistic psychology movement nurtured self-actualization, the wholeness of mind and body, personal responsibility for one's health, and the belief that mental conflict promotes disease. The counterculture's reaction to materialism helped revive naturopathy and other folk practices under "holistic health" and the New Age [9-11]. This metaphysical outlook places a trust in the fundamental goodness of the natural universe and the belief that we warrant favorable outcomes if we follow our "natural" inclinations. Disease is a form of hubris that descends when one trusts in reason over instincts -- one gravitates to healthy choices if one follows one's intuition.

Naturopathy also asserts that a "vital curative force" (which naturopaths confuse with what the Hippocratics called vis medicatrix naturae) flows through vaguely conceptualized channels akin to the "meridians" of TCM. Impedance, or "unbalancing" the flow of this force, can cause disease. Therapy therefore consists of restoring normal flow through "balancing," "cleansing," or "detoxifying" the system. Constrictions of the vital flow can arise from such causes as "devitalized foods," psychological strain, "autointoxication" (toxins usually entering the body through the bowel), metabolic imbalances, colon toxicity, nutrient malabsorption, and "liver sluggishness." [5:102] Germs are seen not as specific disease-causing entities but as parasites that attack a weakened body that has fallen into an unbalanced condition. Since naturopaths believe that diseases spring from this common underlying cause, all sickness would be within their ability to help.

How Do Naturopaths Detect Disease?

Naturopathy's "energies" and "vibrations" cannot be detected by scientific instruments. Most naturopaths use unsound diagnostic and therapeutic devices based on these dubious "life forces." (One that was demonstrated with pride by a prominent British Columbia naturopath whom the senior author debated on TV was a black box with different colored lights that could be shone on samples of hair, sputum, blood, etc. By reading changes in the reflected light that no one but the naturopath could see, he diagnosed the ailments of several donors. The diagnoses turned out to be uniformly wrong.) Naturopaths also defend "applied kinesiology," a pseudoscientific technique for diagnosing "toxicities" by subjectively assessing muscle weaknesses allegedly precipitated by refined sugar, food additives, and even fluorescent overhead lighting. In the mid 1970s, an Australian government Committee of Inquiry [12] concluded that a majority of naturopaths used iridology -- a diagnostic technique based on the notion that pathology anywhere in the body signals its presence through signs in the iris of the eye. We have found that most naturopaths looking for spiritual energies defend Kirlian photography as a diagnostic tool. However, this process, which spiritualists have long believed allows the human aura to be photographed, has a simple, normal physical explanation -- a coronal discharge is created in the gas molecules surrounding animate or inanimate objects that are placed in a high-intensity electric field. This discharge is recorded by a conventional photographic process and has not been shown to have any diagnostic value [13].

Some naturopaths rely on "radiesthesia," which is a form of dowsing. The naturopath passes a pendulum around the patient's body and watches for deviations that pinpoint the site of a problem. One practitioner told us that he likes to use a capsule of an antibiotic as the weight for his pendulum because, being a "bad substance," the antibiotic would "resonate" in proximity to diseased organs. Dowsers and radiesthesiests do not recognize the fact that their own unconscious muscle contractions (ideomotor action) move the pendulum [14].

How Do Naturopaths Treat Disease?

Naturopaths state that their remedies are spiritual as well as physical. The Trinity School of Natural Health offers a Doctor of Naturopathy degree to anyone with no prerequisites on completion of 12 correspondence modules. Its promotional literature states: "The school makes no apology for its stance on issues of faith, such as the creation and nature of man, the resurrection, eternity, or any other subject which does not lend itself to double-blind studies, scientific duplication or investigation, but are essential to the spiritual aspect of the whole person." The practices we encountered in our survey of the occupation ranged from the generally supportable to the improbable to the disproved. The list includes: "natural" herbs and nutritional supplements, biofeedback, relaxation techniques, acupuncture, cupping, and moxibustion (also borrowed from TCM) [3], massage, enemas ("high colonics"), water baths ("hydrotherapy"), heat treatments, aromatherapy, fasting ("cleansing"), hypnosis, reflexology, joint manipulation (e.g., "Rolfing"), "realignment" of the cranial bones, bioenegetics, breathwork, magnetic healing, homeopathic potions, therapeutic touch, faith healing, copper bracelets for arthritis, and various Ayurvedic and Native-American healing practices. One naturopathy home page we visited recommended wearing socks chilled with ice water to "tone up the immune system" and its operator admitted practicing crystal "healing." These treatments and diagnostic aids are ineffective or unproved. Some naturopaths we interviewed laughed at certain items in the list but embraced others that had even less credibility.

History of the Naturopathy Movement

Naturopathy claims affinity with Hippocrates and medical practices of ancient Egypt. Twentieth-century naturopathy owes an even greater debt to the central European "health-spa" movement of the 1700s and 1800s [11]. For instance, much in present-day "natural healing" can be traced to a Silesian shepherd, Vincenz Priessnitz (1791-1851). In tending his flocks, Priessnitz observed that injured animals often sought out streams, then later emerged apparently improved. From this he concluded that cold water was nature's panacea. He tested water on himself and his fellow villagers, starting with sprains and bruises, then cholera and diseases of the heart, lungs, kidney, liver, and brain [5:100]. He pioneered a network of spas throughout Europe that evolved into present variants such as the German therapeutic communities known as the Kurorte. Through these institutions a German naturopath (Heilpraktiker) can offer a collection of alternative therapies (the Kur), following the natural healing philosophy of Priessnitz [15].

Like their colleagues in North America, Heilpraktikers preach "holism" and oppose target-oriented, pharmacologically active substances. The pleasant, often-rural surroundings of these retreats are in keeping with Priessnitz's belief in the therapeutic benefits of bucolic environments. The ancient fascination with "taking the waters" lives on today, as many spas continue to be situated in scenic settings whose spring waters have been extolled (some since since Roman times), somewhat paradoxically, for both their purity and their mineral contents. Different mineral springs have reputations for special efficacy with particular diseases. At the spas, mineral baths may be supplemented by group gymnastics; massage; baths suffused with galvanic electrical fields, herbs, and vitamins; hikes; rest; dietary manipulations; and hot mudpacks. In present-day Germany, the Kur movement generally promotes itself as a preventive strategy and a rehabilitative therapy that strengthens during a period of recuperation rather than as an antidote to specific diseases.

During the nineteenth century, European hydrotherapy ("the water cure") and Naturphilosophie crossed the Atlantic to inspire figures such as Joel Shew and Russell Thacker Trall who opened a hydropathic spa in Lebanon Springs, New York, in 1845. The herbalism extolled by the European imports built on ground prepared by an earlier radical crusade for botanical medicine. It was led by Samuel Thomson, a New Englander with no formal education who taught that since all disease stemmed from loss of bodily heat, the remedy was to restore internal warmth [16]. Thomson claimed this could be accomplished either directly by clearing intestinal "obstructions" so digestion could produce the additional heat, or indirectly by causing perspiration. Thomson's principal ways of achieving this were the strong emetic lobelia inflata and red pepper, combined with steam and hot baths. He opposed the use of all mineral substances because, coming from the ground, they were, by definition, deadly. On the other hand, because herbs grow toward the sun, the life-giving source of heat, Thomson argued that they must refresh one's health. The followers of Thomsonism exhibited the mix of populism and anti-intellectualism that still pervades the naturopathic community today. Thomson's mistrust of orthodox credentials was expressed in his analogy: book learning is to common sense as aristocracy is to democracy and as physicians are to folk healers. We now know the ineffectiveness and harmfulness of orthodox therapeutics in the early nineteenth century. The Thomsonians' skepticism and preference for less violent alternatives to the then orthodox practices of bloodletting, blistering, and purging were not entirely unreasonable.

American naturopathy also has native roots in the "hygienic movement" of health reformers such as Sylvester Graham in the 1830s. A Presbyterian minister, Graham preached the gospel of vegetarianism, sexual moderation, abstinence from alcohol, the virtues of fresh air and exercise, and, of course, the water cure [17]. Graham, whose "Graham crackers" began life as the quintessential whole-grain health food, also influenced John Harvey Kellogg, another religiously inspired health reformer who was physician to the Battle Creek Sanitarium founded by the Seventh-day Adventist prophet, Ellen G. White. There, Kellogg concocted his original cornflakes recipe as a complete vegetarian source of nutrients. During its heyday from 1840 to 1870, hydropathy, as advocated by Kellogg, was practiced at over 200 spas in the U.S. and supported several publications such as the Water Cure Journal and the Hydropathic Review.

The American hygiene movement entered one of its periodic downturns upon the death of its charismatic leader Russell Trall in 1877. Hydrotherapy all but disappeared before being rejuvenated in the 1890s by disciples of another European, Sebastian Kneipp. A Bavarian Catholic priest, Kneipp rekindled enthusiasm for the water cure along with a renewed interest in herbalism and "health foods." He also recommended, quite reasonably, a vigorous outdoor lifestyle. However, he also showed zeal for such "natural" bracers as wearing coarse homespun undergarments, running barefoot on snow, and walking on dewy grass.

American naturopathy was largely regenerated through the efforts of Benedict Lust who merged Kneipp's ideology with the American hydrotherapy and natural hygiene movements [11]. Lust was a German immigrant who contracted tuberculosis, returned to Europe, and recovered after being treated by Kneipp. Lust became the great proselytizer for "Kneippism" in the U.S. where he was commissioned to start schools, societies, magazines, health-food stores, and sanitariums to promote the water cure. Lust purchased the name "naturopathy" from John Scale who had coined the term in 1895 for his own health-care system. The Naturopathic Society of America was founded by Lust in New York City in 1902 and was renamed the American Naturopathic Association (ANA) in 1919. The ANA hoped to welcome under its umbrella virtually any healer who rejected the tenets of the then emerging field of scientific biomedicine. One of the ANA's publications boasted graduates from Nature Cure, hydrotherapy, diet, chiropractic, osteopathy, mechanotherapy, neuropathy, electropathy, mental and suggestive therapeutics, phototherapy, heliotherapy, phytotherapy, and other schools of natural healing [11:372]. Naturopaths still use many of these methods despite lack of validating research.

Because Lust lacked the charisma of the founders of the other competing "drugless healing" modalities -- Andrew Taylor Still (osteopathy) and Daniel David Palmer (chiropractic) -- he was unable to impose a uniform dogma on his followers. Despite a period of rapid growth in the 1920s and 1930s, when 25 states licensed its practice, naturopathy began to decline again in the 1940s. The American Medical Association's 1906 decision to refuse licensure to all but the graduates of colleges acceptable to its Council on Medical Education was finally taking its toll, and the numbers of naturopaths began to dwindle. Upon Lust's death in 1945, the ANA he splintered into a half dozen separate organizations. Chiropractic colleges, many of which had offered naturopathic degrees, largely discontinued the practice, and several competing naturopathic schools sprang up to fill the void, most by offering mail-order degrees. Each grafted onto the virtues of fresh air, exercise, unrefined foods, pure water, light, and herbs its own eccentricities. A number of splinter groups tried to reverse this downward drift by forming a united front under the banner of the American Association of Naturopathic Physicians (AANP) in 1956. Despite some successes, progress remained sluggish while scientific medicine thrived and the AMA opposed "drugless healers" and publicized their low educational standards and shaky scientific support.

During the 1950s, the legislative rights won by earlier naturopaths were rapidly eroded. Naturopathic practice became a gross misdemeanor in the states of Tennessee and Texas and was declared unconstitutional in California, although a "sunset law" of 1964 permitted existing practitioners to continue. The Pacific Northwest bucked this trend, however, preserving its reputation as a sanctuary for maverick social movements and medical systems. Washington, Oregon, and the Canadian province of British Columbia continued to provide a relatively friendly environment for "sanipracters" as naturopaths began to call themselves. Nonetheless, naturopathy had to await maturation of holdovers from the 1960s counterculture, New Age prophets of "naturalism," and "holism" to regain its former popularity. Today, naturopaths are licensed as independent practitioners in 13 states (Alaska, Arizona, California, Connecticut, Hawaii, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington), the District of Columbia, and several Canadian provinces (British Columbia, Manitoba, Ontario, and Saskatchewan) and can legally practice in a few other jurisdictions. Some practitioners hold an acupuncture or chiropractic license that enables them to practice naturopathy in jurisdictions where naturopaths are not licensed.

Education of Naturopaths

The Doctor of Naturopathy (ND) degree is currently offered by four full-time schools of naturopathy in the United States and two in Canada. In 1956 the National College of Naturopathic Medicine was established in Portland, Oregon. A number of smaller institutions and correspondence schools followed, many of them little more than for-profit "diploma mills." [11] In 1978, three Seattle-based graduates of the NCNM founded the John Bastyr College of Naturopathic Medicine, which later became Bastyr University. The Southwest College of Naturopathic Medicine and Health Sciences in Scottsdale, Arizona, was founded in 1992. The University of Bridgeport College of Natural Medicine in Bridgeport, Connecticut, began classes in 1997. According to Raso [5], most of Southwest's funding came from companies marketing dietary supplements, homeopathic remedies, and medicinal herbs. Others, such as Ulett [18], have questioned the ethics of the relationship between naturopaths and the manufacturers and distributors of these products.

In the late 1970s, Bastyr received its Candidacy for Accreditation by the Northwest Association of Schools and Colleges, a first for any naturopathic institution. In 1987, the U.S. Secretary of Education approved the Council on Naturopathic Medical Education (CNME) as an accrediting board for naturopathic schools. Most education-accrediting panels assess the academic merits of the curriculum and professional competence of faculty. The Department of Education and the accrediting board, however, were and are concerned not with academic merit, but solely with "factors such as record keeping, physical assets, financial status, makeup of the governing body, catalogue characteristics, nondiscrimination policy, and self-evaluation system." [5:104] A CNME application for renewal was denied in 2001, but a new application was approved in 2003.

The full-time institutions typically require an undergraduate degree for admission, although not necessarily in science. Our survey of entrance requirements indicated that the minimum grade-point average for admission was quite a bit lower than that of most post-baccalaureate programs. The curricula generally include two years of basic sciences, including human anatomy and physiology, and two years of clinical naturopathy. The basic-science portions of the required curricula appear acceptable, but our investigations incline us to believe that actual delivery has improved little since the aforementioned Australian Committee of Inquiry issued its findings in 1977. After attending some of these courses in person, this committee concluded:

Although the Committee found the syllabuses of many [naturopathic] colleges were reasonable in their coverage of basic biomedical sciences on paper, the actual instruction bore little relationship to the [publicized] course. . . . [Lectures were] exposition[s] of the terminology of the medical sciences, at a level of dictionary definitions, without benefit of depth or the understanding of mechanisms or the broader significance of the concepts [12:74].

Present published naturopathic curricula include the basic science courses taught during the first two years of standard biomedical training, but our discussions with graduates of these programs have revealed glaring deficiencies in their knowledge of human physiology. This is in keeping with the conclusion of the Australian investigating team that the basic science standards in the naturopathy schools were "disappointingly low." [12] How else could a graduate seriously beieve that there are anatomical connections between the iris of the eye and the liver, spleen, pancreas, and other organs that meter their distress, or that "realigning" the bones of the skull is possible or effective?

The catalog of the Canadian College of Naturopathic Medicine also includes such scientifically suspect offerings as homeopathy, hydrotherapy (the "water cure"), and "soft tissue manipulation." We wonder how students at this institution, which requires three terms of college-level chemistry for admission, can fail to balk at homeopathy, whose premises are contradicted by virtually everything they were exposed to in those prerequisite courses. Literature on the Portland-based NCNM's Web page also defends homeopathy, asserting that it "works on a subtle, yet powerful, electromagnetic level. . . to strengthen the body's healing and immune response to provide a lasting cure." "Subtle" in such contexts is a widely used euphemism for "scientifically undetectable." The authors seem oblivious to the harm such a public airing of the college's ignorance of electromagnetism and immunology does to the occupation's scientific pretensions.

The development of naturopathy in Canada largely parallels that in the U.S. Canadian naturopaths depended until 1978 entirely on American schools for their training [19], and Canadian naturopaths from British Columbia had helped found the American colleges in the Pacific Northwest. The first Canadian naturopathic institution, the Ontario College of Naturopathic Medicine, opened its doors in 1978. It subsequently changed its name to the Canadian College of Naturopathic Medicine. Initially, it required entrants to be already certified in an allied health occupation and taught its curriculum on weekends over a three-year period. A four-year, full-time program was instituted in 1983. In Canada, federal and provincial fact-finding commissions have recommended against inclusion of naturopathic services in the national medicare system, on the basis that they lack scientific merit and are so loosely defined as to preclude establishment of acceptable standards of practice [19]. It has since come to light that the responses of some naturopaths to questionnaires sent by one of these investigative bodies, the Canadian Royal Commission on Health Services, were "corrected" by officers of the naturopathic association before they were forwarded to the Commission. In addition, when the Canadian Naturopathic Association (CNA) learned that its members could come under personal scrutiny of the Commission, its president sent the membership a "checklist" for sanitizing their offices to avoid embarrassment if the commissioners came to call. The letter included the following:

Does your library look professional? This is most important: these men are bookworms. Dust your books' well even if you haven't used them recently. . . Get rid of all diplomas not directly related to Naturopathic Medicine. . . The wording on your stationary should be checked. No "quackish" wording or claims must be made; get rid of it at once [20].

The CNA was also invited to submit a formal brief to the Royal Commission. In their submission, naturopaths supported the establishment of the government-sponsored national health-insurance program but fought for individual "freedom of choice of any recognized, accepted method of treatment." Gort and Coburn characterized the supporting arguments for naturopathy as lacking cogency and pointed out that the CNA failed to satisfy the Commission's request for scientific data to support their practices. Similarly, naturopaths in testimony before an Ontario government committee disputed the efficacy of polio vaccination and attacked the concept of immunization. The then president of the Ontario Naturopathic Association was questioned about a "radionics machine" that had been seen in his office. He denied that such devices even exist [19]. Radionics is the present-day version of the crackpot device concocted by the maverick San Francisco doctor, Albert Abrams, in the early 1900s. Dubbed "dean of the gadget quacks" by the AMA, Abrams amassed a huge fortune leasing diagnostic black boxes. Cracking open one of Abrams's contraptions, his contemporary, the physicist Robert Millikan, described the useless jumble of wires and components as "the kind of device a ten-year-old boy would build to fool an eight-year-old."

The recommendations of the official Canadian inquests that have looked into naturopathy have all been negative, a conclusion that was reached independently by a similar committee of inquiry struck by the Australian government. On page 99 of its final report, the Australian panel concluded: "The Committee does not recommend licensing of naturopaths as a vocational group as it considers that such licensing may give a form of official imprimatur to practices which the Committee considers to be unscientific and, at the best, of marginal efficacy." [12] The committee did recommend official oversight, however, to protect the unsuspecting public from scientifically questionable practitioners. Judging from the experience of one observer, when his wife was treated by an Australian naturopath, the standards of education and care did not improve among Australian NDs after the panel issued this indictment [1]. For similar reasons, naturopathy was excluded from the Canadian Medicare plan that was instituted in 1965. Instead of embarking on an effort to improve the scientific status of the profession, the Canadian Naturopathic Association opted for an extensive lobbying campaign. Its leadership recommended that members join clubs frequented by members of Parliament, take legislators to dinner, and contribute to their political coffers.

The province of British Columbia has partially insured naturopathic services since 1965. We wondered how this had come about. In our interviews with naturopaths and their associations, we repeatedly asked for scientific justification for their procedures. While producing nothing of substance, many practitioners argued that the fact that the partial coverage of their services by the British Columbia Medical Services Plan must mean that the Ministry of Health finds them scientifically acceptable. Deciding to pursue this, we contacted the Ministry in Victoria in March 1997. After outlining our request for information, we were referred to an official who identified himself but preferred, understandably, to speak off-the-record. Asked why coverage was extended to some naturopathic treatments, this senior administrator said that (a) the ruling was based on political rather than scientific grounds; (b) the Ministry was unaware of any scientific research supporting naturopathy; and (c) coverage of the services had been extended in response to consumer demand and intensive lobbying by naturopaths. He also hinted that cost-saving had also been a factor, because naturopaths are compensated at a lower rate than MDs and siphon off a portion of those with vague, self-defined ailments or chronic conditions who would otherwise congest the medical services sector at a much higher cost per patient.

Is Naturopathy a Pseudoscience?

Bunge [4] has provided a useful checklist for recognizing pseudosciences. While naturopathy would qualify on almost all of Bunge's criteria, four are especially noteworthy. They are paraphrased in the numbered statements below.

1. Pseudosciences are stagnant, preferring to perpetuate unquestionable dogma from the past rather than progressing as new knowledge emerges from intellectual ferment, debate, internal criticism, and, above all, new research. When ideas do change in pseudosciences, they do so in a cosmetic way and usually in response to popular fashions rather than empirical research.

In this electronic age, one might expect an organization's page on the World Wide Web to extol its newest theories and latest scientific breakthroughs. Visiting the Web page of the Canadian Naturopathic Education and Research Society, however, we found instead reverence for the past as, for ample, in a laudatory obituary for the late Joseph Boucher, ND. Boucher had been a member of the British Columbia Naturopathic governing body and had helped found John Bastyr College -- in other words, someone who surely would have been on the cutting edge (if there were one). An internationally acclaimed spokesman for naturopathy, Boucher remained, with approval of the Web page's originators, a strong champion of the eccentric California naturopath, Stanford Claunch, whose ideas date back to the earlier part of the century. Claunch was a founder of "polarity therapy," which claims that numerous diseases result when an alleged left-right electrical polarization of the body becomes disordered. This is treated by the naturopath intuitively "synching" with the patient's "energy field" and laying on of hands to correct the "imbalance." Claunch also advocated "craniosacral therapy," which contends that this energetic imbalance stems from misalignment of the skull bones which must be manually forced back into a healthy configuration. Ninety-five percent of the population allegedly suffers from cranial misalignment. Of course, in the adult, the cranial bones are fused and not "adjustable." Moreover, no competent electrophysiologist has ever detected the electrical fields postulated by Claunch. Undaunted, his supporters still claim that movements of the cranial bones cause movements in the sacrum and vice versa, offering further avenues for therapeutic manipulation. Claunch's other major contribution was his treatise Exploding the Germ Theory, an amusing display of biological fancy, again cited with approval on the society's Web page.

In 1997, after seeking better fare by contacting the Canadian Naturopathic Education and Research Society and the Bastyr University Research Department in person, we had to conclude that research from naturopaths in support of their practices is still a promissory note. They were able to point to virtually none of the core empirical findings, institutionalized review processes, refereed granting procedures, rigorous methodologies, etc., that typify a legitimate scientific enterprise. Pressed for details of the research mentioned on Bastyr University's Web page, their spokesperson, Carlo Calabrese, ND, indicated that their primary efforts to date had been surveys of user satisfaction that employed such subjective yardsticks as patients' self-ratings of their "quality of life." He said a large study was under way that would survey a sample of HIV-positive patients who use "alternative" treatments. Because almost all were also receiving conventional biomedical care and there seemed to be little attempt to control for such confounds, it was unclear how they could determine what would cause any differences in their measures. Concerted efforts to get several other naturopathic associations to steer us to scientific research that supports their premises produced only a handful of references from legitimate journals testing the efficacy of certain herbs. There was nothing to support the associations' eccentric beliefs about nutrition or any of the fringe therapies discussed earlier. The evidence naturopaths themselves presented was almost entirely composed of anecdotes and personal testimonials. In our own search of the relevant scientific literature, we found no compelling support, but we did find other results from empirical evaluations that question the value of the "holistic" approach of naturopathy [21,22].

Very little naturopathic research has been published in peer-reviewed scientific journals. In 2003, the Journal of the American Medical Association published a study which found that echinacea was no more effective than a placebo in treating children with upper respiratory infections [23]. It now appears that naturopathy's academic community can do some significant research, but how much the outcome of well-designed studies will influence naturopathy's flawed theories and irrational practices remains to be seem.

2. Pseudosciences exhibit a general outlook that countenances immaterial entities and processes and untestable hypotheses that are accepted on authority rather than on the basis of logic and empirical evidence.

Radionics, polarity therapy, and therapeutic touch are a few of the naturopathic standbys that postulate immaterial "energy" fields that legitimate scientists cannot detect. Homeopathy, too, posits subtle "vibrations" to explain how pure water can "remember" in order to produce the effects of molecules it no longer contains. As we have seen, naturopathy is thoroughly vitalistic, riddled with unique but undetectable forces and concepts of flow and balance that cannot be empirically tested. Naturopathic "mission statements" we encountered typically repeatedly the "spiritual" nature of healing.

3. Pseudosciences are isolated from relevant areas of science that they ought to learn from and contribute to. Bogus sciences have little interaction with and are often proud of their isolation from authentic sciences whose findings bear on their claims. Pseudosciences avoid contact with disciplines with which they ought to interact on a regular basis.

It is telling that naturopathy has always had to establish its own colleges to teach its philosophy and practices because no reputable institution of higher learning has been willing to issue naturopathic degrees. As we have seen, naturopaths practically never do research that could be accepted by conventional biomedical journals. Nor is the occupation affiliated with any of the academic umbrella groups (such as the American Association for the Advancement of Science, the U.S. National Academy of Sciences, the Learned Societies of Canada, or the British Royal Society) that promote cooperation and sharing of information among specialized disciplines.

4. Pseudosciences promote hypotheses that are contradicted by an overwhelming body of data from legitimate fields of research.

Applied kinesiology, radionics, craniosacral manipulation, homeopathy, are examples of dubious practices that clash with scientific knowledge. Similarly, naturopaths, who pride themselves on being specialists in nutrition typically espouse the unfounded claims propagated by the "health-food" industry. Scientifically trained dietitians have documented the isolation of naturopathy from mainstream science in this regard [24,25]. The Australian commission, referred to earlier, found that naturopaths in that country were disseminating potentially dangerous nutritional advice such as the avoidance by children younger than five years old of all sources of protein. Naturopathic publications assert that "natural" vitamins (e.g., vitamin C from rose hips) are better for one's health than the identical molecules synthesized on the chemist's bench. A magical orientation is apparent in the oft-heard slur that manufactured vitamins must be bad because they are derived from "coal tar." This is equivalent to arguing that a house constructed of recycled bricks from a brothel will be inferior to one built of bricks from a demolished church.

If naturopathy is so poorly validated, why would seemingly well educated therapists and their clients accept such antiscientific approaches to medicine? There are many cognitive biases that can lead both purveyors and purchasers to think that bogus therapies are beneficial [26]. A historical tradition and habits of mind have contributed to the will to believe such practices. These include errors of causality and misattribution (thinking a treatment causes improvement because it precedes the improvement), the power of ritual (physical applications, supplement taking), and suggestion.

Curiously, surveys show that naturopaths' clientele are above average in earnings, suggesting a relative advantage in education as well [19,27]. In addition, the distribution is skewed in favor of female over male clients.

Conclusion

Our inquiry provided naturopaths and their professional associations ample opportunity to refute the conclusions of several major commissions of inquiry that deemed their therapeutic rationale lacking in scientific credibility. None of our informants was able to convince us that the field had taken these earlier critiques to heart; in fact, few seemed to recognize that a problem still exists. Throughout, we found underestimation of the power of the placebo. At the same time, our own bibliographic searches failed to discover any properly controlled clinical trials that supported claims of naturopathy, except in a few limited areas where naturopaths' advice concurs with that of orthodox medical science. Where naturopathy and biomedicine disagree, the evidence is uniformly to the detriment of the former. We therefore conclude that clients drawn to naturopaths are either unaware of the scientific deficiencies of naturopathic practice or choose to disregard them on ideological grounds. Naturopathy seems to appeal to magical thinking in people with nostalgia for a bygone "Golden Age" of simplicity when things moved at a more leisurely pace -- a halcyon world that probably never existed [28]. Despite the scientific shortcomings of the occupation, there continues to be considerable satisfaction among clients. In addition to benefiting from the placebo effect, many find their sociopolitical outlook nurtured by naturopaths' antiestablishment, antitechnology stance, and others find reinforcement for their faith in a benevolent, human-centered universe. Naturopaths also attract people who, for one reason or another, have been dissatisfied with their contacts with biomedicine. They appeal to people with illnesses with a strong psychosomatic component and those who have chronic conditions for which biomedicine, at present, can offer little. Naturopaths' elaborate history-taking and prolonged "hands-on" interactions provide the human contact and social support that, perhaps unknowingly, many of the so-called worried well are really seeking. They also cater to those with exaggerated fears of side effects of standard medical treatments.

To their credit, naturopaths emphasize the benefits of a healthy lifestyle, the value of prevention, and the desirability of using the least intrusive intervention that will do the job. However, their means of achieving these ideals leave much to be desired while fostering scientific illiteracy in the process. Like most pseudoscientific systems, naturopathy offers comfort to its adherents. But comfort afforded is not truth implied.

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Dr. Beyerstein is a biopsychologist at Simon Fraser University in Burnaby, British Columbia, Canada. An earlier version of this article was published in 1998 in The Scientific Review of Alternative Medicine.

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This article was posted on May 12, 2004.