Naturopathy and Science: The Evidence-Based Medicine Debate

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What evidence-based medicine means

Evidence-based medicine (EBM) is defined, in a widely quoted 1996 wording, as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. [1] It combines the clinician's experience, the patient's values and the best available research. The same encyclopedia entry notes a limit: trial results describe groups and may not fit every person or population. [1] The debate over naturopathy is largely about how well its methods meet this standard, one treatment at a time.

Two different questions

• Does a whole package of naturopathic care help? This tests several things together, such as diet advice, supplements and counseling.
• Does each ingredient of the package work on its own? This needs separate trials, and a good result for a package does not prove each part works.

Lab-value changes and how people feel are also different outcomes, and the tables below name which one a study measured.

What the research says

1. Whole-system naturopathic care

   Promising but limited

   A 2019 scoping review found 33 published studies (n = 9,859) and its authors conclude the studies predominantly showed evidence of efficacy. [2]

2. One trial: chronic low back pain

   Promising but limited (one small trial; a bundle of methods)

   75 postal employees were randomized to naturopathic care (dietary counseling, deep breathing and acupuncture) or physiotherapy education. [3] The naturopathic group reported greater improvement over 12 weeks. [3]

3. Homeopathy, which some naturopathic practices offer

   Insufficient evidence

   NCCIH says there is little evidence it works as a treatment for any specific condition. [4]

4. Alternative medicine alone for curable cancer

   Evidence of harm (observational; not naturopathy only)

   An observational study found greater risk of death than with conventional treatment. [5]

5. Physical activity, often part of lifestyle advice

   Established

   WHO says activity contributes to prevention and management of diseases such as cardiovascular disease, cancer and diabetes. [6]

6. "Vital force" as an explanation

   Traditional framework, not a measured mechanism

   Critics say the energies postulated by vitalists cannot be measured by scientific methods. [7]

Reading the scoping review carefully

We read only the review's abstract. A scoping review maps what research exists; the abstract does not tell us how each study's risk of bias was weighed, so we cannot judge the strength of the conclusion. The authors' listed affiliations include a naturopathic research centre, a naturopathic institute and a company named Integria Healthcare, while their statement says no competing financial interests exist. [2] Likewise, the back pain trial was run by authors based at a naturopathic college. [3] We also did not see in the abstract whether participants or assessors were blinded, and the comparison was an education booklet, not a sham treatment. Placebo and expectation effects can matter in trials like this. See understanding evidence.

Proper evidence not found for large, independent, long-term trials of whole-system naturopathic care across conditions. We looked at a PubMed search on naturopathy and evidence, the scoping review above and NCCIH's naturopathy page.

How the profession describes its own research culture

• The Institute for Natural Medicine says stronger clinical research is needed for integrative medicine to become widely adopted. [8]
• In an Australian survey of 219 people in naturopathic medicine, 46.6 percent agreed the regulatory environment was ready for evidence implementation. [9]
• An Australian survey of 479 naturopaths and Western herbalists found 94 percent rated randomized trials as essential or important, and 99 percent said that for well-documented traditional evidence. [10]
• A Canadian course for 61 NDs raised skill and knowledge, but not substantively attitudes or use of evidence. [11]

These are self-reported surveys and small studies, not measures of patient outcomes.

What critics add

Quackwatch (Stephen Barrett, M.D., 2013) says no scientific evidence supports vitalism. [7] A 2014 Science-Based Medicine post says vitalism is the central belief and that a philosophy, rather than objective evidence, guides what is promoted. [12] On the profession side, the Institute for Natural Medicine says more clinical research is needed. [8] The two sides are compared at criticism of naturopathy and the profession's response.

Using this in real life

Ask what a test or treatment is for and what study supports that use. Do not use unproven approaches to replace or delay cancer treatment. [13] Vaccine information should come from health authorities such as the WHO. [14] Use how to evaluate a therapy claim and the history in Lust, Kneipp and the nature cure movement.