Life is nothing but a word which means ignorance, and when we characterize a phenomenon as vital, it amounts to saying that we do not know its immediate cause or its conditions. . . . The habit of vitalistic explanation makes us credulous and promotes the introduction of absurd data into science.

 Would-be consumers searching books on “alternative medicine” for beliefs common to all naturopaths, or the empirical research that informs their practices, will be surprised to find how few authors, pro or con, could find sufficient material to justify a chapter of its own for this popular healing art. That is because it is exceedingly difficult to find postulates or data that are unique to the profession. The most eclectic of the “alternative” healers, naturopaths readily change their modus operandi in response to changing fads in popular pseudoscience.  As far as a consistent philosophy of diagnostics and therapeutics is concerned, one is reminded of what the San Francisco enthusiast Gertrude Stein once said of rival Oakland: “There’s no there there.”  From our extensive interviews with naturopaths and reviewing their writings, we are forced to conclude that the only things that unite the majority of practitioners are a penchant for magical thinking, a weak grasp of basic science, and a messianic rejection of “allopathy” as naturopaths like to call scientific biomedicine.

 Because the profession has always lacked a coherent theoretical or therapeutic rationale, a client thinking of engaging a naturopath’s services has no way of knowing in advance what he or she might be subjected to.  Practices and educational standards vary so widely that a client might encounter anything from common-sense lifestyle advice—such as admonitions to eat a healthy diet, rest and exercise more, and reduce stress in their lives—to a stunning array of misinformation and scientifically implausible treatments that permeate the field (see, e.g., the experience of O’Connor, 1987).

 If there is a glue that binds the diverse and changing patchwork of naturopathic practices together, it is espousal of the teachings of the early 19th-Century Romantic movement known as Naturphilosophie.  The central tenet of this movement, which affected not only the Romantic poets and artists of the era but some noted scientists as well, was 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 (Grove 1988).  Much like the concept of  “Qi” in Oriental philosophy and medicine, this mystical force is thought to pervade all things.  Since both naturopathy and Traditional Chinese Medicine (TCM) teach that “balancing” this  mystical force in one’s body is the way to health, it was only to be expected that, as TCM gained popularity in North America and Europe, naturopaths would also climb aboard this bandwagon, as they had so many others in the past. TCM is now taught in most of the naturopathic colleges we surveyed.  In states such as California that no longer grant licensure to naturopaths, many evade the restriction by practicing under the legislation that regulates acupuncturists.

 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.  Naive 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 indifference, if not antipathy, toward empirical research endemic in the field to this day.

 In keeping with their holistic bent, naturopaths view sickness as a generalized breakdown of the body in response to “unnatural” events in the environment.  As such, it is remedied by overall strengthening of the body’s resistance.  This is in opposition to biomedicine’s view of disease as a localized malfunction due to specific pathogens or degenerative processes that attack particular organ systems.  Biomedicine therefore tailors its treatments to the system and pathogen concerned, whereas naturopathy claims to “treat the whole person.”

The Magical Underpinnings of Naturopathy.

 Pseudosciences adopt the outward trappings of legitimate sciences in hopes of appropriating their prestige and economic clout.  Despite these superficial resemblances, pseudosciences lack the conceptual and methodological rigor of real sciences, not to mention their storehouse of replicable findings (Bunge 1984). Although pseudosciences go to great lengths to appear scientific, one need only scratch the surface to reveal their magical roots.  Raso (1994, Ch. 8) exposes the quasi-religious basis of naturopathy through the writings of its principal exponents.  According to its past and present adherents, the fundamental assumption of naturopathy is that healing stems from a supernatural “life force” that looks much like the abandoned principle from pre-scientific biology known as elan vitale (Brandon 1985). This undetectable force, which biologists once believed distinguished living from inanimate matter, is supposed to emanate from a cosmos whose natural order is governed by essentially moral laws—as opposed to the impersonal, mechanistic ones sought by mainstream scientists.  For proponents of naturopathy, “natural laws” are not generalizations from rigorous observation and experimentation, but rather they are the moralistic dictates of an anthropomorphic “Nature” (usually capitalized to emphasize its purposeful, theistic properties).  According to those of this persuasion, we are rewarded or punished, health-wise, in accordance with our ability to maintain harmony and balance with these animistic 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, a prominent advocate of the “Natural Hygiene” movement (quoted by Raso 1994, p. 98):

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!

Licencing Naturopaths.

 As of 1992, only seven US states (Arizona, Connecticut, Florida, Hawaii, Nevada, Oregon, and Washington) and the District of Columbia had laws permitting the practice of naturopathy. According to the home page of the American Association of Naturopathic Physicians (AANP) on the World Wide Web, the states of Maine, Utah, and Vermont added themselves to this list in 1996. California no longer licences new naturopaths but permits those who were already in practice in 1964 to continue under a “sunset clause.”  Others practice in California under licensure as acupuncturists.  Because most states do not register naturopaths, an accurate estimate of their numbers is difficult to obtain.  The AANP put the total in early 1992 at 1,044 but a spokesperson, replying to queries by Raso in 1994 dropped the number to “more than 800.”  The same official indicated that efforts to gain licensure were underway in an additional sixteen states.  At the time of writing, four of the ten Canadian provinces (British Columbia, Ontario, Manitoba, and Saskatchewan) licence naturopaths and two others (Alberta and Nova Scotia) have applications pending.

From where did naturopathic dictates arise?

 Just as naturopathy reflects the 19th-century romanticism from which it sprang, it in turn bears the imprint of a much older tradition with roots in the ancient Greek mystery cults and the teachings of the pre-Socratic philosophers Heraclitis and Parmenedes (Frankel 1973).  Their descendants inspired the “counterculture” of the 1960s and ‘70s with its passion for egalitarianism, naturalness, and the primitive, all entwined in a mystical narcissism that equates truth with emotion rather than reason (Roszak 1969).  The same Zeitgeist nurtured the humanistic psychology movement which preached 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 “back to nature” reaction to the ills of technological and materialistic society helped revive the fortunes of naturopathy and a host of other folk practices under the “holistic health” and New Age banners (Basil 1988, Schultz 1989, Baer 1992).

 Echoing Rousseau’s quarrel with Voltaire, this metaphysical outlook places a naive trust in the fundamental goodness of the natural universe and the belief that favorable outcomes are guaranteed if we simply follow our “natural” inclinations.  Disease for holders of this worldview is a form of hubris that brings us up short when we mistakenly trust in reason over our health-promoting instincts.  That is, it is axiomatic that people will gravitate to healthy choices if they simply follow their intuitive bent, rather than giving in to the false pride of believing that analysis can improve on nature.

 Naturopaths assert that a “vital curative force” (which they confuse with what the Hippocratics called vis medicatrix naturae) flows through vaguely conceptualized channels akin to the equally elusive “meridians” of Traditional Chinese Medicine.  For them, anything that impedes or “unbalances” the flow of this ethereal “energy” can cause disease. Therapy therefore consists of restoring normal flow through “balancing,” “cleansing,” or “detoxifying” the system.  For naturopaths, constrictions of the vital flow can arise from such causes as “devitalized foods,” psychological strain, “autointoxication,” metabolic imbalances, colon toxicity, nutrient malabsorp-tion, and “liver sluggishness” (Raso 1994, p. 102).  Germs are seen not as specific disease-causing entities but parasites that attack a weakened body that has fallen into an unbalanced condition. Since most naturopaths believe that all diseases spring from this common underlying cause, there is hardly any form of sickness that is beyond their ability to help.

How do naturopaths detect disease?

 Given their penchant for vague “energies” and “vibrations” that cannot be detected by ordinary scientific instruments, naturopaths are prime customers for dubious diagnostic and therapeutic devices that supposedly tap these spiritual forces.  A display of quaint machinery of this sort now resides in a special museum founded by the collector Bob McCoy in Minneapolis (Ver Berkmoes 1990).  Naturopaths have also been among the most staunch defenders of “applied kinesiology,” a pseudoscientific technique for diagnosing “toxicities” by subjectively assessing muscle weaknesses that suddenly appear in someone exposed to such “unhealthy” things as refined sugar, food additives, or fluorescent overhead lighting.  In a similar vein, our own interactions with naturopaths confirmed the finding of an Australian government Committee of Inquiry (Australian Government Publishing Service 1977) that the majority of naturopaths are devotees of iridology.  This is an offbeat diagnostic technique based on the notion that pathology anywhere in the body signals its presence through signs in the iris of the eye (Davidson 1951; Worrall 1985).  We also found that most naturopaths, grasping for any shred of scientific support for the spiritual energies they posit, defend Kirilian photography as a diagnostic tool. This process, which spiritualists have long believed allows the human aura to be photographed, has several properties of interest to physicists and engineers but it has never shown itself useful in any way for diagnosing physical or psychological ailments (Singer 1981).  And then there is “radiesthesia,” a form of dowsing where the naturopath passes a pendulum around the patient’s body and watches for deviations that pinpoint the site of his or her 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.  For an explanation for why dowsers and radiesthesiests do not recognize the fact that it is their own subconscious muscle contractions that move the pendulum, see Hyman (1996).  Hyman (personal communication) once asked a radiesthetic healer if he had tried this procedure with double blind controls.  He answered that they stopped testing it that way because the results had been disappointing!

How do naturopaths treat disease?

 Naturopaths readily agree that their panoply of remedies is spiritual as well as physical.  As stated in the promotional literature of the Trinity School of Natural Health, which offers a Doctor of Naturopathy degree to anyone, with no prerequisites, upon completion of twelve of their correspondence modules:

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 profession ranged from the generally supportable to the demonstrably absurd. The list includes, among other things: “natural” herbs and nutritional supplements, biofeedback, relaxation techniques, acupuncture, cupping, and moxibustion (also borrowed from TCM—see Beyerstein and Sampson 1996), massage, enemas (“high colonics”), water baths (“hydrotherapy”), heat treatments, aromatherapy, fasting (“cleansing”), hypnosis, reflexology and joint manipulation (e.g., “Rolphing”), “realignment” of the cranial bones, zone therapy, pop psychology positive thinking nostrums, bioenergetics, breath-work, exercise and yoga, 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 on the World Wide Web recommended wearing socks chilled with ice water to tone up the immune system and many of our contacts admitted practicing that New Age standby, crystal healing.
 It was frequently the case in our interviews with naturopaths that an interviewee would laugh alongside us when denigrating one or another entry in this long list of fringe practices, but then in the next breath earnestly embrace another method that enjoys even less scientific credibility.  Needless to say, the vast majority of these treatments and diagnostic aids cannot withstand scientific scrutiny.  Readers wishing to know more about how they have failed are invited to consult the relevant listings in the index of the present volume or the compendium of “alternative” practices compiled by Raso (1994).

 We now turn to the question of why seemingly well educated therapists and their clients would accept such blatantly anti-scientific approaches to medicine.  Beyerstein (Ch. xx, this volume) discusses the many cognitive biases that can lead both purveyors and purchasers to think that bogus therapies are beneficial.  In what follows, we present a historical overview of the climate and habits of mind that have contributed to the will to believe in practices such as naturopathy.  In passing, it is worth noting that surveys seeking to determine who patronizes naturopaths indicate that their clientele is above average in earnings, suggesting a relative advantage in education as well (Gort and Coburn 1988).  In addition, the distribution is skewed in favor of female over male clients.

History of the naturopathy movement.

 Although modern naturopaths like to claim affinity with Hippocrates and medical practices of ancient Egypt, 20th century naturopathy owes a greater debt to the Central European “health spa” movement of the 1700s and 1800s (Baer 1992).  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, apparently to emerge greatly improved.  From this he concluded that cold water was nature’s panacea, a conviction he proceeded to test to his satisfaction on himself and his fellow villagers.  Starting with sprains and bruises, Priessnitz went on to treat cholera and diseases of the heart, lungs, kidney, liver, and brain (Raso 1994, 100).  He pioneered a network of spas throughout Europe that evolved into national variants such as the German therapeutic communities known as the Kurorte. Through these institutions a German naturopath (Heilpractker) can offer a collection of alternative therapies (the Kur), following the natural healing philosophy of Priessnitz (Maretzki 1987).  Like their colleagues in North America, Heilprakters preach “holism,” decrying the use of target oriented, pharmacologically active substances.  The pleasant, often rural surroundings of these retreats are in keeping with the 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 the scenic settings whose spring waters have been extolled since Roman times, somewhat paradoxically, for both their purity and their mineral contents.  Different mineral springs have developed reputations for special efficacy with particular diseases.  At the spas, mineral baths are supplemented by group gymnastics, massage, baths suffused with galvanic electrical fields, herbs and vitamins, hikes, rest, dietary manipulations, and hot mud packs.  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 19th 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 one Samuel Thompson, 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 (Starr 1982, p. 51). Thomson claimed this could be accomplished either directly by clearing “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 they must refresh one’s health.

 Politically, the followers of Thomsonism exhibited the mix of populism and anti-intellectualism that remains a feature of naturopathy to this day.  Thomson’s mistrust of orthodox credentials was expressed in his analogy that book learning is to common sense as aristocracy is to democracy and as physicians are to folk healers. Given what we now know of the ineffectiveness and harmfulness of orthodox therapeutics in the early 19th century, the Thomsonians’ skepticism and preference for less violent alternatives to the then orthodox practices of  bloodletting, blistering, and purging was not entirely unreasonable.

 American naturopathy also has native roots in the “hygienic movement” popularized by 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 (Armstrong and Armstrong 1991, Ch. 6).  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 corn flakes 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 US 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 went overboard in his zeal for such eccentric “natural” bracers as wearing coarse, homespun undergarments, running barefoot on snow, and walking on dewy grass.

 American naturopathy as we now know it is largely the culmination of the efforts of Benedict Lust to merge Kneipp’s ideology with the American hydrotherapy and natural hygiene movements (Baer 1992).  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 US where he was commissioned to start schools, societies, magazines, healthfood stores, and sanitariums to promote the water cure.  Lust purchased the name “naturo-pathy” from, John Scale who had coined the term in 1895 for his own health care system.  In 1902, the Naturopathic Society of America was founded by Lust in New York City.  It 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 rational and progressive schools of Natural healing (quoted in Baer 1992, p. 372).

 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 once again in the 1940s.  The effects of the 1906 decision by the American Medical Association (AMA) to refuse licensure to all but the graduates of colleges acceptable to its Council on Medical Education was finally beginning to take its toll and the numbers of naturopaths began to dwindle.  Upon Lust’s death in 1945, the ANA he founded splintered into a half dozen separate organizations. Chiropractic colleges, many of which had until then also offered naturopathic degrees (the so-called “mixers”), 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, unrefined foods, pure water, light, herbs, and exercise its own idiosyncratic health fixations. Attempts to reverse this downward drift by regrouping to form a united front led to an amalgamation of the splinter groups under the banner of the American Association of Naturopathic Physicians (AANP) in 1956.  Despite some successes, progress remained sluggish.  This was due in part to the burgeoning public prestige of scientific medicine following its highly visible successes during World War II and the growing hegemony of biomedicine in the governmental, insurance, educational, research, and technological sectors. During the 1950s, the legislative rights won by earlier naturopaths were rapidly eroded as vigorous opposition to the “drugless healers” by the AMA widely publicized the low educational standards and shaky scientific support of their competitors.

 After the war, legislative restrictions further hampered the growth of naturopathy.  Its practice became a gross misdemeanor in the states of Tennessee and Texas. It was declared unconstitutional in California, though the “sunset law” of 1964 permitted existing practitioners to continue but prohibited new licenses.  The Pacific Northwest bucked this trend, however, preserving its reputation as a sanctuary for maverick social movements and medical systems. Washington and Oregon and the neighboring Canadian province of British Columbia continued to provide a relatively friendly environment for “sanipracters” as naturopaths briefly began to call themselves.  Nonetheless, naturopathy had to await maturation of holdovers from the 1960s

counterculture, the New Age prophets of “naturalism” and “holism,” to really come into its own once again.

Education of Naturopaths.

 The Doctor of Naturopathy (N.D.) degree is currently offered by three full-time schools of naturopathy in the US and one in Canada.  In 1956 the National College of Naturopathic Medicine (NCNM) was established in Portland, Oregon. A number of smaller institutions and correspondence schools followed, many of them little more than for-profit “diploma mills” (for details, see Baer 1992, or consult the several naturopathy home pages on the World Wide Web).  In 1978, three Seattle-based graduates of the NCNM founded the John Bastyr College of Naturopathic Medicine (JBCNM), later to become Bastyr University.  Recently, this contingent of four-year non-correspondence institutions was augmented by the advent of the Southwest College of Naturopathic Medicine and Health Sciences in Scottsdale, Arizona.  According to Raso (1994), most of the newcomer’s start-up funding came from companies that market dietary supplements, homeopathic remedies, and medicinal herbs. Others, such as Ulett (1996), have questioned the ethics of the cozy relationship between naturopaths and the manufacturers of these products.

 In the late 1970s, JBCNM received its Candidacy for Accreditation by the Northwest Association of Schools and Colleges, a first for any naturopathic institution.  In 1987, the US Secretary of Education approved the Council on Naturopathic Medical Education (CNME) as an accrediting board for naturopathic schools.  Unlike most accrediting panels, however, which assess the academic merits of the curriculum and professional competence of faculty, this one is concerned solely with “factors such as record keeping, physical assets, financial status, makeup of the governing body, catalogue characteristics, nondiscrimination policy, and self-evaluation system” (Raso 1994, p. 104).

 Our review of naturopathic education revealed an extreme reluctance on the part of accredited universities to offer naturopathic degrees.  It therefor piqued our curiosity to hear that the University of Bridgeport, a small but respected liberal arts college in Connecticut, was considering breaking ranks with the rest of the academic community on this issue.  Further examination revealed that the U. of B. had already made a far bigger break.  Although it does not appear in any of its current promotional literature, it seems that the college went bankrupt in 1992 and was purchased by the Unification Church of Reverend Sun Myung Moon, i.e.,  the “Moonies.”  Along with replacing the former faculty with devotees of Reverend Moon, the college has turned its curriculum into a cornucopia of pseudoscience and New Age nonsense.  It would hardly elevate naturopathy’s esteem among legitimate academics to ally itself with the Moonies’ propaganda machine.

 The full-time naturopathic colleges typically require an undergraduate degree for admission, though not necessarily in science.  Our survey of entrance requirements indicated that the minimum grade point average for admission tends to be 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 (Australian Government Publishing Service 1977, p. 74).

The published naturopathic curricula perused by the present authors list an impressive collection of courses that might be found in standard biomedical training and, while they were unable to gauge the rigor with which these courses are taught, debates the first author has had 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, mentioned earlier, who concluded:

The Committee visited the colleges offering courses in various aspects of naturopathy.  In every case, it was considered that the standards in the orthodox biomedical sciences were disappointingly low.  (Australian Government Publishing Service 1977, p. 74)

How else could a graduate leave a program seriously believing 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 (see below) is either possible or profitable (in any but the monetary sense of the word)?

 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.”  One wonders 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 profession’s scientific pretensions.  No evidence was offered in favor of this therapeutic claim.

 The development of naturopathy in Canada largely parallels that in the US. Canadian naturopaths depended until 1978 entirely on American schools for their training (Gort and Coburn 1988) 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, a series of federal and provincial fact-finding commissions has 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 (Gort and Coburn 1988).  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 (the so-called “Mills Commission,” after its chair—see Mills, 1966), were “corrected” by officers of the naturopathic association before they were forwarded to the Commission.  In addition, when the Canadian Naturopathic Association (CNA) learned its members could come under personal scrutiny of the Mills Commission, its then 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 book-worms.  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.  (Letter from the CNA, quoted by Gort and Coburn 1988, p. 1065).

 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 that eventually came into being, 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 did not enhance their credibility in testimony before a subsequent Ontario government committee where they disputed the efficacy of polio vaccination and attacked the concept of immunization in general.  These hearings degenerated into a farce when the then president of the Ontario Naturopathic Association was questioned about a “radionics machine” that had been seen in his office.  He resorted to hilarious circumlocutions to deny that such devices even exist (Gort and Coburn 1988).

 The recommendations of the several 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 p. 99 of  its final report, the Australian panel concluded:
The Committee does not recommend licencing 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 (Australian Government Publishing Service 1977).

The committee did recommend official oversight, however, to protect the unsuspecting public from scientifically questionable practitioners.  Judging from O’Connor’s experience when his wife was treated by an Australian naturopath, the standards of education and care did not improve among N.D.s “down under” after the panel issued this indictment (O’Connor 1987).
 

 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.  At the time of writing, only one Canadian jurisdiction has relented, the authors’ home province of British Columbia, which 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 none of any substance was forthcoming, many practitioners argued that the fact that the British Columbia Medical Services Plan partially covers their services, must mean that the Ministry of Health finds them scientifically acceptable.  Deciding to pursue this, the second author contacted the Ministry in Victoria in March of 1997.  After outlining her request for information, she was told that a qualified spokesperson would return the call, which was done promptly by an official who identified himself but preferred, understandably, to speak off the record. Asked the basis on which the decision was made to extend coverage to some naturopathic treatments, this senior administrator answered that the ruling had been based on political rather than scientific grounds.  He said the Ministry was unaware of any scientific research supporting naturopathy and he assumed there was none, adding that if we found any to please let him know.  He said that 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 M.D.s. They 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 based on pseudoscience?

 Bunge (1984) has provided a useful checklist for recognizing pseudosciences.  While naturopathy would qualify on almost all of Bunge’s criteria, there are a few that 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 example, in a laudatory obituary for the late Joseph Boucher, N.D.  Boucher had been a member of the British Columbia Naturopathic governing body and one who helped found the John Bastyr College—in other words, someone who surely would have been on the cutting edge of the profession.  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 the 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.” More dangerously, 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, passing familiarity with vertebrate anatomy would reveal that, 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 ignorance, again cited with approval on the society’s Web page.
 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.  Naturopaths conduct little research themselves, and when they do, it is generally defective by current scientific standards.  Pressed for details of the research mentioned on Bastyr University’s Web page, their spokesperson, Carlo Calabrese, N.D., indicated that their primary efforts to date have been surveys of user-satisfaction that employ such subjective yardsticks as patients’ self-ratings of their “quality of life.”  He said a large study is currently under way, surveying a sample of HIV positive patients who use “alternative” treatments.  Since almost all are also receiving conventional biomedical care, and there seemed to be little attempt to control for such confounds, it is unclear how they hope to determine what is responsible for differences in their measures, if any.  None of this research has apparently been submitted to peer reviewed scientific journals.

 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 (some of which admittedly show promise—see Sampson and Beyerstein 1996), but nothing to support the associations’ eccentric beliefs about  nutrition or any of the fringe therapies discussed earlier.  Exhibiting the tell-tale signs of a dubious therapy presented by Beyerstein in Chapter XX, 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 naturo-pathy (e.g., Bagenal et al. 1990; Southwood et al. 1990).

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 has been espoused by naturopaths with nothing but the eccentric musings of its founder, Samuel Hannemann (1755-1843) to back it up.  It too posits subtle “vibrations” to explain how pure water can “remember” in order to produce the effects of molecules it no longer contains (see Chapter xx, this volume).   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 repeatedly stressed 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 under its auspices.  As we have seen, naturopaths practically never do research that could be accepted by conventional biomedical journals.  Nor is the profession 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.

 The foregoing sections on applied kinesiology, radionics, craniosacral manipulation, homeopathy, etc., are all examples where the curricula in the premier teaching institutions in the field of naturopathy actively promote dogma that is strongly refuted by scientific research.  Similarly, naturopaths, who pride themselves on being specialists in nutrition, are major proponents of the nutritional pseudoscience propagated by the “health food” industry.  Scientifically-trained dieticians have documented the isolation of naturopathy from mainstream science in this regard (Raso 1993; Barrett and Herbert, 1992). The Australian commission, referred to earlier, found naturopaths in that country were disseminating potentially dangerous nutritional advice such as the avoidance of all sources of protein by children under five years of age.  And as proof of their misunderstanding of biochemistry, naturopathic publications continue to assert fallacies such as the claim that “natural” vitamins (e.g., vitamin C from rose hips) will be more beneficial to one’s health than the identical molecules synthesized on the chemist’s bench.  Their 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.

Conclusion.

 In our research for this chapter, we provided naturopaths and their professional associations ample opportunity to refute the conclusions of several major commissions of inquiry over the years 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, precious few seemed to recognize that a problem still exists.  Throughout, we found a profound 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 the profession, 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 well-established scientific deficiencies of naturopathic practice or choose wilfully to disregard them on ideological grounds.  As shown above, naturopathy appeals to magical thinkers who exhibit a nostalgia for a bygone “Golden Age” of simplicity when things moved at a more leisurely pace—a halcyon world that probably never existed (Bettman 1974).  Despite the scientific shortcomings of the profession, there continues to be considerable patient-satisfaction among those who frequent naturopaths’ offices.  In addition to benefitting from the placebo effect, many find their sociopolitical outlook nurtured by naturopaths’ anti-establishment, anti-technology stance and others find reinforcement for their faith in a benevolent, human-centered universe.  Naturopaths also attract those who, for one reason or another, have been dissatisfied with their contacts with orthodox medicine.  They appeal to those whose illnesses have a strong psychosomatic component and those who suffer from chronic conditions for which, regrettably, medical science, 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 fear of side effects of standard biomedical 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 beliefs, naturopathy offers comfort to its adherents.  But comfort afforded is not truth implied.
 

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