Appearances matter. I do not expect anyone to object to that conclusion in reference to art or in the day-to-day appreciation of beauty in its various forms. But aesthetics in science? Is science not the one domain where we can isolate and mitigate the forces that colour our perception? Can we not harness the powers of logic and rationality to steer us towards conclusions that are true rather than conclusions that please us?
Simply exploring the role of the aesthetic in science can be troubling; it reveals a bias of human cognition where all the pretty hypotheses are developed into full-fledged theories while the less desirable wait at home, hoping a dreamy scientist will one day reach outside the institutional norms and bring them to the prom of ideas. One must look no further than the search for a single theory of everything as a scientific pursuit predicated on the beauty of simplicity and totality.
While the exploration of aesthetic influence within science is certainly fascinating, there exists also an aesthetic of science and the institutions that support and surround it. These are the cues – interpreted both consciously and subconsciously – that confer scientific authority to ideas without granting them any particular merit with regard to their descriptive power of reality.
One needs not look far for popular imagery and stereotypes in science. If you Google “scientist“, the search yields a large number of photos (including many stock photos) depicting lab coated chemists hard at work with their various laboratory apparati, yet most scientists are not chemists and lab coats are not particularly pervasive across other specialties. For better or worse, these aesthetic stereotypes invade the public consciousness, impacting not only how professionals in science and medicine are portrayed, but becoming symbolic of the authority and legitimacy of those professionals. As a result, the aesthetic itself has become a tool for exploiting public trust.
Whether purposefully manipulative or entirely subconscious, various movements have adopted aspects of the established aesthetic within the scientific and mainstream medical domain. Take – for example – a Google search for “naturopathic doctor“. What do you see? White coats, stethoscopes, lab spaces, and – notably absent from our search for scientists – an obvious appeal to the natural aesthetic that has so infected our consumer culture. One could very well argue that the naturopathic profession was built largely to appeal to our aesthetic values. Indeed, many have argued that the profession merely takes advantage of such deficiencies in the medical system. This is perhaps most evident in the narrow conditions most commonly treated and utilized as naturopathic “success stories”; such lists often contain self-limiting conditions which tend to resolve without any intervention at all. Patients do not need treatment, but do they need the comfort of being heard and cared for?
Of course, any profession that is built on such thin facades as borrowed apparel is doomed to fail. I can dress a monkey up as a physician, but at some point you’re going to question if eating the lice he grooms out of your daughter’s hair is really proper clinical etiquette. But what if he didn’t eat the lice? What if he could write and speak? What if that monkey didn’t look like a monkey? Evidently, the aesthetic of scientific legitimacy is not a simple binary, but a continuum of qualities that are context and observer dependent.
For some people, a clean office, lab coat, and stethoscope may be sufficient for putting their faith into a practitioner. For others, they may be sufficiently persuaded by formal credentials. Of course, persuasion of patients alone is not sufficient to create a professional health paradigm; in Canada, provincial jurisdictions have the final say over what types of practices are permitted and whether they receive public funding. This is, after all, why we have elected representatives and regulators. In theory, their job is to evaluate objective criteria against our shared values to create a system that best balances access to healthcare, patient safety, consumer choice, value, and more. Luckily, it seems to take more than a white coat to fool these folks. Unfortunately, this means that deception just gets that much more complicated.
The naturopathic establishment knows it cannot exist without some level of scientific validation, or – at very least – the appearance of scientific validation. This notion launched a movement that is perhaps best typified by the US-based National Center for Complementary and Integrative Health (NCCIH), which despite billions of dollars of funding has not produced particularly impactful research and has failed to report clinical trials. What do they have? An aesthetic that relies on buzzwords to convey a unique patient-centered value and studies that are scientific only in appearance.
A shocking proportion of the scientific literature consists of works that do not simply fail to expand upon human knowledge, but impede such developments by promoting false notions, often the result of vested interests. While these studies typically rely on methodology of such poor rigor that they fail to impact the broad scientific consensus, they can be wielded as devastating weapons against the public consciousness for political and social gains. Indeed, they generally possess all of the aesthetic markers that the lay public rely on to distinguish scientific work from news, opinion, commentary, etc. And when the peer-review process fails, such works can even make their way into prestigious journals that confer an additional veneer of legitimacy.
One need not look beyond the border to find such egregious abuses of science. Recently, I’ve become familiar with a naturopath-driven cancer institute close to home: the Ottawa Integrative Cancer Centre. The clinic claims to provide treatments for “any stage of cancer” as well as “prevention of cancer”. Throughout the website, there are many claims that the clinical practices employed are “evidence-informed” or “evidence-based“, but are they really?
Let’s explore the “Evidence-Based Monographs” page. The page includes various monographs targeting both patients and health professions with rousing titles such as “Flax for Breast Cancer“. Virtually all of the documents make extraordinarily strong suggestions of benefits for compounds that simply are not supported by quality research. Take for example Mistletoe. The author(s?) rely on carefully suggestive language; instead of claiming that mistletoe has definitive benefits, they say that it “is most commonly used in cancer care” for a number of purposes, which include reducing tumour size and slowing disease progression. Elsewhere on the site, you can find claims that “Mistletoe Improves Overall Survival” referencing a single dated study. More recently, the preponderance of evidence indicates that “the literature does not provide any indication to prescribe mistletoe to patients with cancer” yet this review is nowhere to be found on the website of a clinic that just happens to offer intravenous mistletoe therapy for cancer patients.
At what point does this become the abuse of science for its aesthetic? At what point does this become a serious ethical breach of informed consent? Obviously, I don’t have a window into day-to-day clinical practices, but the website really does not instill any confidence that vulnerable cancer patients are receiving accurate information. Is this really the type of clinic we are comfortable permitting patients to be lured into spending their money and last hours in?
This is all – quite frankly – infuriating, but we have barely scratched the surface here. My first run-in with the OICC was through a Twitter exchange with Jean Seely, who just happens to be the sister of the clinic’s Executive Director: Dugald Seely. Jean pointed out that patients were provided “helpful support” without “false expectations.” Well, if the website reflects what goes on in the clinic, I am highly skeptical of both claims. She went on to cite a “good” study performed by her brother, which didn’t touch on cancer at all, but on “Naturopathic medicine for the prevention of cardiovascular disease“. The study is a perfect example of science in appearance only; while the authors conclude that the findings “support the hypothesis that the addition of naturopathic care to enhanced usual care may reduce the risk of cardiovascular disease among those at high risk” the study entirely fails to adequately test that hypothesis. Let’s dig in.
The study was designed as a trial to compare enhanced usual care to enhanced usual care with the addition of naturopathic care among middle aged postal workers with an increased risk of cardiovascular disease in a number of major Canadian cities (classic A vs. A+B). Billed as a “pragmatic” approach, the study – if properly designed – should give insight into the practical benefits that naturopaths can offer patients via regular visits. Unfortunately, the study was only pragmatic in the sense that its design effectively guaranteed positive results, but not through the magic of naturopathy.
Let’s take a step back. What do we know about the clinical practice of naturopaths? We know that most of what Canadian naturopaths advertise is an assortment of completely bogus therapies, including homeopathy, chelation, colon cleanses, and various forms of IV therapy. We know that a large proportion of Canadian naturopaths advertise phony treatments and diagnostic techniques related to allergies and asthma. We know that a vast number of naturopathic websites (and presumably practitioners) promote vaccination misinformation, which is undoubtedly related to the high prevalence of vaccination hesitancy among patients who see naturopaths (indeed, I have personally submitted complaints on this issue to various regulatory bodies that have yet to take any action). We know that a large number of naturopaths offer completely pseudoscientific “stem cell” therapies. We also know that patients who receive “complementary medicine” for their cancer are more likely to refuse medical care, and ultimately, are at a greater risk of death.
By these measures, the naturopathic profession in Canada is largely anti-science and a measurable threat to public health. So how did Seely et al. work this reality into their pragmatic study design? Well instead of opening the floodgates to the multitude of dangerous and pseudoscientific practices popular among Canadian naturopaths, the authors cherry-picked the acceptable interventions that could be utilized by the participating naturopaths:
- Dietary interventions (tailored diet, caloric restriction, etc.)
- Supplement-based interventions (fish oil, fibre, lutein, etc.)
- Lifestyle interventions (exercise)
And how did they track what interventions were chosen? They didn’t:
“Because a range of interventions were recommended to participants in the naturopathic group, the frequency and composition of each recommendation as well as participant adherence are not reported. We did not have direct control over the care given to the control group; thus, we did not track or report recommendations made by the participants’ family physicians. “
So what were the results of added diet and lifestyle counselling? The group receiving “naturopathic” counselling improved marginally over the control group on the primary endpoints relating to cardiovascular risk (there are some statistical issues, but those are really trivial compared to the fundamental conceptual flaws of the paper). What is worth noting, is that the “naturopathic group reported significantly more weekly minutes of moderate exercise.”
So… wait a minute. The study took a group of naturopaths, restricted them to traditional interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction, including exercise, which is known to reduce CVD risk, and – as a result – the naturopathic group exercised more, reducing their risk, and they have the audacity to attribute these benefits to the magic of “naturopathic medicine“? If I was a betting man, I would bet that a Richard Simmons VHS would outperform these amateurs.
So what did the study really tell us? Well, ignoring the other major methodological deficiencies, the most generous interpretation tells us that naturopaths could have a positive effect when they act as glorified diet and fitness motivators, but could this not be accomplished more efficiently with a science-based specialty that practices exclusively in this domain? Did the authors forget about the following more science-based practitioners who can give advice in this domain:
- Occupational therapists
- Physical therapists
- Personal trainers
- Nurse practitioners
- Chiropractors (vitalists excluded, sorry)
- Karen from Farm Boy
Or did they simply ignore them in the quest to legitimize their field with the scientific aesthetic? Because once you peel back the assumptions and the misleading language, that’s all this study is: an aesthetic of science.
Studies like these are among the many ways that alternative practitioners misuse the aesthetic legitimacy of existing establishments to bolster their own professional identity. I continue to be shocked that journals do not require authors to report conflicts of interest when their work is primarily intended to promote their own profession rather than to ask legitimate scientific questions relating to novel medical interventions. The evidence shows that these types of practitioners will use any means available to elevate their reputation, from producing and relying on bad science, to claiming that 3 years of arbitrary undergraduate schooling constitutes “university-level pre-medical training.”
Worse still, the Canadian associations that represent naturopaths are nothing short of ignorant and dangerous. The Ontario Association of Naturopathic Doctors – for example – has promoted turmeric as a cancer treatment, homeopathic alternatives to vaccines, and high dose IV vitamin C therapy as a possible cancer cure. In this context, the monkey in the white coat doesn’t look so bad…
David Gorski, in his article looking at funding for dubious research performed out of the OICC, said it best: “In the end, naturopaths like Dugald Seely are cosplaying real doctors and clinical trials are their props.” Whether conscious of not, these practitioners co-opt the scientific aesthetic for personal and professional promotion without adopting firm scientific principles. Look for substance here, and you will be shocked at what you find.