COMMENTARY

Acting in Defense of the Medical Literature

David L. Katz, MD, MPH, FACPM, FACP

Disclosures

March 24, 2004

The misleading and objectionable elements of Dr. Kimball Atwood's so-called "special" article on naturopathy[1] begin with the title. In medical exchange, we are accustomed to use of the word "critical" as an indication of thorough scrutiny, balanced consideration, and, to the extent our innate biases permit, objective judgment. It is in the vernacular that "critical" means simply disparaging. Sanctioning the use of the term in the context of a medical article where it connotes the former but denotes the latter is, with due respect, an editorial lapse on your part.

That this article is flagrantly biased is almost too self-evident to warrant discussion. None can deny that there is much to question under the expansive rubric of "complementary and alternative medicine" (CAM) or, for that matter, the lesser breadth of naturopathy. But there is much to acknowledge as well. Naturopathic physicians recognized the importance of omega-3 fatty acids to health long before their conventional counterparts; we have only recently begun to catch up.[2] They are likely ahead of us with regard to the role of chromium in mitigating insulin resistance as well, an issue toward which the NIH has recently directed not inconsiderable resources.[3] As Dr. Atwood indulged in a litany of unflattering anecdotes, one might counter with a parade of testimonials from patients with chronic fatigue syndrome, fibromyalgia, premenstrual syndrome, atopy, autoimmune disease, or osteoarthritis who found lasting relief under the care of a naturopath that eluded them within the purview of conventional medicine.

Equally noteworthy is the implication that, by contrast to naturopathy, conventional medicine is unsullied by questionable practices. Are we not substantially responsible for antibiotic resistance through our injudicious use of these drugs for viral infection? Do we not routinely ignore evidence that diverges from our native preferences, the history of right heart catheterization a salient example?[4] Dr. Atwood might revisit Hamlet's precautions to Horatio if inclined to think all truth, and only truth, resides within the realm of our allopathic philosophy. Dr. Atwood's naturopathic counterpart, inspired to serve up a commensurately "critical" appraisal of allopathic medicine, would not want for material.

From extensive professional experience I might well be roused to praise and defend naturopathic physicians with whom I have worked closely, but am here to do neither. Rather, I am acting in defense of the medical literature where critical appraisal should be something other than an opportunity to broadcast one's personal prejudices.

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