I have explored health and healing from the very scientific to the very woo. In my line of work, I get all kinds of questions about various modalities and therapies - what works, what’s total bunk, what might be beneficial but the jury’s still out… As a researcher and clinician, I try not to speak outside of my area of expertise and instead teach critical thinking skills and provide information and context to help you navigate questions you may have.
I take this job very seriously.
I believe that we, as scientists, should not speak outside of our area of expertise. We can offer some opinions and insights, but should always defer to the actual subject matter experts. However, as clinicians, we are often asked to provide opinions on all kinds of things we may not be subject matter experts in. That’s why I believe strongly in actually becoming certified in anything I am asked to repeatedly speak to.
What is important to understand with wellness research is that, like many emerging scientific fields, it can be very difficult to separate early research that is legitimate from bunk. We’ve seen this play out over Covid-19 with Hydroxychloroquine and Ivermectin research. Early research is rife with poor research design, small sample sizes, and charlatans looking to make a quick buck. This can be extremely confusing for the general public, whose trust in science and medicine in general has been eroding over the years.
I realize that my career choices can make me seem like a bit of an interesting mix of science and pseudo-science. Many folks make a lot of assumptions about what my positions on many things are, based on my various educational pursuits. I have had a number of folks with hidden agendas try to befriend me based on an expectation that I was going to support their beliefs and offer credibility to their misconceptions about health and wellness. This was especially true during my Unified Health research project. Many folks in the Wellness World thought that I was going to completely legitimize their professions or belief structures. Others were very interested in the aspect of the project about monetizing the complementary and alternative medicine (CAM) therapies for use in providing free care to those who need it and can’t afford it - if something can make that much money, there are those who will want to benefit from it in less altruistic ways. When these groups and individuals found out that a large part of that project was also about how to design proper regulations around those professions to protect the public and weed out the charlatans so that those predatory individuals could not use the results in self-benefitting ways… Well. Let’s just say there were a lot of very unhappy individuals.
I believe that there is good in many of these professions. I believe that they have a legitimate place within the medical fields. I also believe that they tend to make exaggerated claims around what can and can’t be helped by their treatments. I believe that there is a generalized lack of well done research that needs to happen to sort out what conditions can and can’t be improved by what professions and even what type of individual is more likely to benefit. I think that there is a legitimate case to be made for ‘the good that many of these professions provide to patients is a decrease in the stress response, as well as an increase in the overall wellbeing and quality of life experienced by the patient.’ I don’t think that that benefit is negligible nor unimportant. But I also believe that it is secondary to actual medical care and treatment. It should be in addition to, not in place of.
Now, I also believe in patient autonomy and an individual’s right to make decisions and choices for themselves, especially with regard to their medical treatment. However, these choices are based on the concept of informed consent. Informed consent means that we have an ethical duty to understand and explain to our patients and clients the risks and benefits of any given treatment. The patient/client has to be able to understand this information to be able to make these choices for themselves. This is why you’ll see cases in the media sometimes about religious freedom, especially when it comes to the treatment of minors, and who actually should get to make medical decisions for someone who is deemed unable to decide it for themselves.
What I have come to understand is that there is a large contingent of people who have flocked to the CAM therapies who, in fact, are seeking alternatives to their own treatment the way that a particular religion might. There are a number of religions that refuse certain medical treatments based on their beliefs and it is not our job to force those treatments on them. We can support them as best we can and give them the best information that we have available. The same is true for a number of the folks in the Wellness World. It is best to view the ideologies of the Wellness World as a type of religion, and it can help put some of their fervently held belief structures into context. They will hold to their beliefs the same way that a religious zealot will. Logic and data are not going to change those beliefs for the majority of these individuals.
However, it is important for the general population to be made aware that there are factions inside of what has become the Wellness Industry - and make no mistake, it is an industry now - that are necessary for being able to judge the relevance of the information that comes from them, the same way that the understanding that medical viewpoints from someone who is a Jehovah’s Witness will be very different than from someone who is Christian, Buddhist, Muslim, etc. Cultural understandings are a very important lens to view and disseminate health information through. It is also extremely important to respect these various viewpoints. For example, a fervently Christian physician who does not believe in medical abortion may not be willing to provide one to their patient. This is information that should be known and provided both to the medical community and the public at large so that people can make a better informed consent choice about receiving care from this particular physician. Someone who is also pro-life may wish to be treated by them, where someone who is pro-choice may not. This same concept needs to be extended to the Wellness World. Which, for the most part has been happening. However, many tend to demonize the entire profession rather than use the information appropriately. We would not demonize the entire profession of gynaecology and obstetrics because of a pro-life/pro-choice physician (though, some do), but we will demonize all of Naturopathy practitioners because of the beliefs held by one practitioner. That’s not helpful for the general public. They see that hypocrisy and then want to stick up for the entire profession. It’s unhelpful to the ultimate goal of protecting patients and the general public from quacks.
Instead, understanding what the risks and benefits of Naturopathy are, what medical conditions they may help, which ones they may hurt, what advice they may give, and which practitioners are legitimate and which follow dangerous practices allows you to have better informed consent discussions with your patients. It arms your patients, who, quite frankly, are probably going to do it anyway, and actually helps keep them safe. It’s applying a harm reduction approach rather than an abstinence model to the woo and wellness worlds.
My own views have evolved tremendously in the time that I have been researching and practicing various professions - where in the treatment program and to what extent various therapies and modalities might be useful has changed a lot over time, as has my understanding of the various motivations behind the various Wellness Industry factions. Some are innocent enough, others are downright criminal. It is important, as a healthcare provider, that I understand and respect the large range of health literacies, beliefs, cultural identities, etc., of the individual in front of me and the community at large to best treat my patients/clients.
Something that I think Covid has been making abundantly clear for people is that the Wellness World is not benign. It is filled with rabid ideologues who can be quite prolific in their health-related misinformation. Which, when the world wasn’t facing a global health crisis, seemed harmless enough. But when it comes to an actual health issue - this misinformation can be deadly.
Oncologists, for instance, have battled this for years. There are benign Wellness Gurus who will advise for traditional treatment approaches and seek to make the experience of them more pleasant for the individual. This can range from things like dietary advice during chemotherapy to manual therapies for relaxation. Within a certain range, these therapies can add in a quality of life component that is measurable.
Where this becomes problematic, however, is when this advice becomes predatory and advocates for wellness treatments INSTEAD of traditional therapies. There are three main groups who do this - 1) ill-informed practitioners who lack a background in science and don’t understand the context for when their profession may or may not be useful. For example, a manual osteopath who has only had a background in massage therapy or yoga versus someone who has an undergraduate degree in a health-related science plus a manual therapy (which used to be the case, but due to changes in admissions requirements there are now a lot more of the former and fewer of the latter in Canada) may make a recommendation based on incomplete knowledge and the Dunning-Krueger effect. This poor recommendation is not malicious in nature. This individual just doesn’t know what they don’t know. 2) A malicious actor who is predatory in nature. They purposefully mislead the public using scare tactics to sell their garbage and snake oil therapies. The Wellness World is mostly unregulated so they face few, if any, consequences for leading people astray with bogus health claims. 3) The general public who doesn’t know the difference between 1 and 2 who then, armed with that misinformation and a newfound mistrust of the medical community, start to share the bogus claims widely. Group 1, not knowing how to accurately judge the claims made by group 2 will oftentimes lend credence to the general public’s furor. And by this point, group 4) practitioners who know better and try to speak out, get hammered by group 2 who has effectively weaponized groups 1 and 3, which leads to growth of groups 1 and 3 until the whole thing collapses based on the actual research coming out in overwhelming amounts that show that everyone got duped. By that time, group 2 people have absconded with their money, or have moved on to the next bunk claim, and the cycle repeats.
The thing that I find fascinating about this has been that the general public doesn’t seem to learn that this is the cycle. Instead, they just get more and more confused and more easily mislead by the next misinformation peddler. This is why faith in medicine and experts has been eroding. No one can tell what to believe anymore. This is why misinformation needs to be addressed. We have been heading down a very dangerous path for a while now, and it’s time to do something about it. Proper regulations for these professions have to be made. There need to be actual consequences for practitioners who spread misinformation, especially the predatory ones. And we need better mechanisms in place to judge misinformation. We need educational campaigns to help increase scientific literacy for the general population. And we need to figure out a way to all work together to achieve that.
Start by asking yourself - why would someone want to fight against protecting the public from predatory practitioners? The answer, unfortunately, is that it’s because they are one. Keep that in mind when deciding who to listen to online or in person.
Fighting misinformation is a bit like the arguments for vaccination - you might not get super sick from Covid, but the people you spread it to might. Anyone who doesn’t care about that, well, we all might want to do some real introspection on what the psychological traits of someone who doesn’t care about harming others might be… Is that the person you want to side with over someone who genuinely cares about protecting others? If it is, cool. If it’s not, also cool. But I know who’s opinion I am going to weigh more heavily when judging what they share and spread online…
As always, until next time, folks!