Author: Akshat Rathi
Date: September 30, 2017
One Friday afternoon in May 2014, Britt Hermes was scheduled to treat one of her cancer patients with an injection of Ukrain. This wasn’t especially unusual; people often came to Hermes, a naturopath in Arizona, for the treatment. That day, though, an expected shipment of the drug hadn’t arrived, and Hermes’s patients weren’t happy. They had been promised that Ukrain given on a strict schedule would help them when nothing else was working. So she asked her boss what was going on.
“In response, he made an off-hand remark: ‘Oh don’t worry. Most likely the FDA [Food and Drug Administration] confiscated it. It’ll just arrive late,’” Hermes recalls today. When she asked him what he meant, he fumbled. “He realized that he may have said something he shouldn’t have.”
Complementary medicine therapies drawn from traditional practices, ranging from massage and vitamin supplements to acupuncture and meditation, are today becoming broadly incorporated into mainstream medicine as more scientific studies validate their efficacy. But naturopathy, a belief system built on the concept that “nature knows best” when it comes to healing, takes it a step further. Practitioners use a host of pseudoscientific techniques including energy healing and homeopathy that can be not only ineffective, but dangerous. Instead of thinking about the techniques as adjunct therapies to proven modern medicine, many naturopaths will reject the pharmaceuticals and other treatments that we know save lives.
Over her seven years of training and practice, Hermes had had doubts about naturopathy, but she had always found ways to dismiss them. This time, however, her boss’s comment worried her: Was she doing something illegal? Could she be in trouble?
Hermes went home and began to Google. She first looked up Ukrain, and uncovered reports of studies showing the drug to be ineffective at best, and worse, potentially the cause of nasty side effects like tumor bleeding and liver toxicity. She read on and realized Ukrain hadn’t passed the clinical trials required for FDA approval. She looked up some of the other therapies frequently used by naturopaths—ozone treatment, injections of hydrogen peroxide, bloody radiation therapy—and realized that none of them were FDA-approved.
“The whole house of cards came crashing down”
“The whole house of cards came crashing down for me,” she recalls. “On Monday, once I had figured out the different pieces of the story, I was in a lawyer’s office getting representation.”
Months later, after giving up her job, Hermes began blogging about the problems she saw in the practice of naturopathy. She was rapidly embraced by a loose community of skeptics who dedicate themselves to promoting critical thinking and evidence-based medicine; it isn’t easy to find someone with Hermes’s intimate knowledge of the inner workings of alternative medicine—and who is willing to speak candidly about the problems of the field. In 2016, just over a year after she began blogging, Hermes’s blog “Naturopathic Diaries” won the Ockham award for the best blog of the year given by The Skeptics magazine.
Subject: A former patient saying hello:)
I was a patient of yours. Your recommendations yielded no greater relief of my symptoms than anything else I have tried before or since. I stumbled across your blog tonight and I must say my mind is a little blown in a good way. I hold no anger or resentment—you were doing your job to the best of your ability and no one was forcing me to see you. Thank you for your brave, clear writing. I hope it sheds light on some of the crazy out there.
Hermes has given up her dream of becoming a doctor and instead has dedicated her life to saving patients and would-be doctors from falling for the naturopathy claims that she once so confidently made. But larger forces now want to silence her.
Bastyr University, where she trained to become a naturopath and whose education she has been publicly criticizing in recent years, has threatened to take her to court unless she stops publishing what the school’s lawyers allege are “willfully false and misleading comments” with “express intent of disparaging Bastyr.” Hermes has no plans to be cowed by the threats.
Over hours of conversation, I found Hermes to be a sharp thinker and an articulate speaker. But something kept bugging me: How could it have been that someone like Hermes remained ignorant for so long in an age when Google is at nearly everyone’s fingertips? And more importantly: Why is it rare to find examples of people like Hermes, people who for whatever reason may have believed something demonstrably false but are able to change their mind when confronted with evidence to the contrary? As I tried to unpack her story, I realized it offered a rare peek into how troubling beliefs are created in the information age, how they are reinforced in echo chambers, and how some people can break out.
BUYING INTO THE SYSTEM
Hermes grew up in a rich neighborhood in Ventura County, in southern California, and she partially attributes her career path to the material comfort of her early life. “A lot of people with disposable income seem to be drawn to alternative medicine,” she says. “The community I grew up in was into wellness treatments, whether acupuncture or ayurvedic spas.”
Her first direct experience with alternative medicine came when she was 16. Red spots started showing up all over her body, and in less than three weeks she went from obsessing about lipsticks and nail polish to desperately seeking a cure for psoriasis.
Her mother, who also suffered from the life-long condition, booked an appointment for Hermes with her own dermatologist. And like he did for her mother, the doctor prescribed steroids for Hermes. But she had seen what the disease had done to her mother, who suffers from bad side effects due to years of medication, such scars on her skin and a severely compromised immune system. Hermes wanted an alternative.
“He brushed me off. ‘Suck it up and get over it, kid,’ he said.”
“I asked him whether diet or such could help,” she recalls. “He brushed me off. ‘Suck it up and get over it, kid,’ he said. That was a turning point in my life.”
She didn’t get over it. Instead, she went to the library. (It was the year 2000 and accessing the internet wasn’t always easy.) “I was using a card catalogue and reading any book that mentioned psoriasis,” Hermes says. Somewhere she read that cod-liver oil would help her, and then made her dad drive around to find a place selling the stuff. “My skin got better, and I’ve never had a psoriasis breakout like that first time,” she says. “I was taking steroids too, of course, but I attributed the remission to the alternative therapies I tried.”
Subject: Thank you from a medical student
Over the years I have seen my parents quit jobs, choose to spend what little money they have on expensive “natural” products, and sever relationships with family over beliefs of pseudoscience. I am tired of watching people get hurt or hurt others over warm-fuzzy ideas. From the bottom of my heart I want to thank you for your journey. I’m certain it has been incredibly difficult. You may not be practicing medicine with patients in the way you initially thought, but your efforts are making a difference that will inevitably help the sick.
After earning an undergraduate degree in psychology, Hermes decided she wanted to become a doctor—but not like the dermatologist who treated her psoriasis. That’s when she came across Bastyr University’s naturopathy course. It seemed perfect.
True believers say the first advocate of naturopathy was the Father of Medicine himself, Hippocrates. The more mundane truth is that the term was popularized in the early 1900s by the Benedict Lust, who learned his techniques from the German practitioner Sebastian Kniepp. Lust came to the US to spread the use of “drugless therapies,” and he found instant success, creating a base of followers. Naturopathy flourished in the country until the 1940s, when the American Medical Association (AMA) began campaigning against medical practices lacking rigorous evidence of efficacy. The result was the near extinction of naturopathy in the US, with only five states offering licenses in 1958.
True believers say the first advocate of naturopathy was the Father of Medicine himself, Hippocrates.
But since the 1970s, thanks to the “holistic health” movement, there has been a revival in interest in naturopathy according to University of Arkansas social anthropologist Hans Baer. Today, as many as 15 US states offer licenses to naturopaths (though only the state of Washington requires insurance companies to reimburse naturopathic treatment). There are also more than a half-dozen schools in North America that dole out Doctor of Naturopathy (ND) degrees—including Bastyr, which has campuses in Kenmore, Washington and San Diego, California.
“When I was looking at the Bastyr website and reading phrases like ‘supported by scientific research’ and ‘drawn from peer-reviewed journals,’ the keywords I was trained to look for were there,” she says. “Bastyr described itself as the ‘Harvard of naturopathic medicine.’ I felt like I was choosing a program that was preparing me to study medicine and research natural therapies and be part of the broader medical field.”
To be sure what she was getting into was legit, Hermes even visited naturopaths.“It felt like a regular doctor’s office. There was a receptionist and a waiting room. Naturopaths were wearing white coats and had stethoscopes around their necks,” Hermes says. “The visual cues were there. They looked like doctors to me.”
HOW TO BECOME A DOCTOR
Naturopathy appeals to many because it seems to offer more than medical doctors alone. “Naturopathic physicians now claim to be primary care physicians proficient in the practice of both ‘conventional’ and ‘natural’ medicine,” Kimball Atwood, an anesthesiologist and assistant professor at Tufts University, wrote in 2003. Experts who’ve looked at naturopathy’s claims closely have found mostly deficiencies. “Their training…amounts to a small fraction of that of medical doctors who practice primary care,” Atwood wrote. “An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices.” But these deficiencies are not easy to find for an undergrad looking to sources and people that would only confirm her biases.
Subject: HELP!!! Just started Naturopathic School at Bastyr
I thought Bastyr would have more science-based natural medicine but I’m finding that it is not the case. The professor also discussed how Bastyr had an astrologist who would help with medicine. By this point in class, I’m terrified that I made the wrong decision.
When Hermes started at Bastyr University, it seemed like other medical schools she had read about. There were classes in anatomy, physiology, and pharmacology. Students dissected cadavers and got clinical practice, spending time with Bastyr naturopaths treating actual patients.
“When I enrolled, I thought ‘alternative medicine’ was mostly lifestyle, like diet and exercise—a practice that tries to mitigate the use of drugs,” Hermes says. “I wasn’t aware of all these different systems of medicine.”
Homeopathy has been shown to be at best a placebo.
Take homeopathy, for instance, which works on two principles. First, “like cures like.” So, for example, since chopped onions make you cry, it follows that if you want to treat hay fever, which also produces runny eyes, you should drink onion juice. Second, “dilution increases potency.” So the onion juice should be diluted to such an extent there isn’t a single molecule of it left in the solution—in other words, until the point where even if for some reason it did work, there’d be no way for scientists to determine that it was in fact a potent therapy. (There is no proof onion juice can treat the symptoms of hay fever.) Suffice it to say that these ideas go completely against any established scientific principle; homeopathy has been shown to be at best a placebo.
“I definitely had moments where I felt cognitive dissonance,” Hermes says. “In homeopathy class, for instance, what was being taught seemed to defy scientific principles. But at the same time, I felt, in order to be the best medical practitioner I could be, it was important to remain open-minded.”
To some extent, Hermes’ worries were alleviated by the training Bastyr was giving her in clinical practice. In the university’s outpatient clinic, Hermes was able to spend time on patient-care shifts, and she liked the approach the facility promoted. “A lot of the care we offered at the Bastyr clinic had counselling to it, because you spend a lot of time talking to the patient and really getting to know them by asking about minutiae in their lives: how many hours they sleep at night or what their stress level is like,” Hermes recalls. She enjoyed spending time with patients, and fell in love with the experience of working through their problems. That’s an aspect of this flavor of naturopathy from which the western model of medicine could stand to take a lesson. Experts have, in recent years, begun to push for a health care model that offers patients plenty of time with their providers, and asks doctors to consider a patient’s whole life—sleep, stress, diet, work, relationships—not just the one symptom that triggered a visit.
Still the doubts came back to haunt her. In physical medicine, for instance, she was exposed to “energy healing,” a belief system among naturopaths that says simple touching can manipulate biological pathways. Like homeopathy, there are no known scientific principles that support energy healing. (Bastyr University shared studies that conclude research in energy healing is limited.)
Halfway through her time in Bastyr, Hermes realized that maybe she had made a mistake. She started to think traditional medical training would have been a much better choice. But she was already $80,000 in debt. Worse, if she wanted to go to a proper medical school, she would have to study for and pass the MCAT exam, which wasn’t needed to get into Bastyr.
“I made a decision to become as much a physician as possible”
“The idea of starting over was too daunting. So I made a decision to become as much a physician as possible” within the naturopath system, Hermes says. “I did that by consulting medical sources instead of naturopathic sources. Instead of having a herbal medicine book on my desk, I had the drug formulary book. I was working hard to convince myself that I was practicing safely and effectively.” She became a licensed naturopath under her maiden name, Britt Deegan.
WRITING ON THE WALL
Things began to go downhill for Hermes soon after she graduated with her ND degree. The naturopathic remedies she was trained to use weren’t working on her patients. Some even had negative reactions to herbal therapies she had prescribed. But Hermes held back from acting on her doubts, until the Ukrain episode.
There are plenty of examples of naturopathic therapies going seriously wrong. Earlier this year, a California-based naturopath killed a 30-year-old woman by giving her an intravenous injection of turmeric. A report from the FDA found that the injection contained castor oil, which had a warning label that said “Caution: For manufacturing or laboratory use only.”
Then there’s the case of Ezekiel Stephan. In February 2012, David and Collet Stephan used naturopathic remedies rather than medical treatment to fight their 19-month-old’s bacterial meningitis. The infant died in March of that year. In 2016, David was sentenced to prison and Collet to house arrest for being “willfully blind” about the life-threatening risks to their son. The naturopath that the Stephans relied on wasn’t charged.
Subject: thank you
I am going through a divorce where the number one point of contention is my spouse’s insistence on naturopathy treatment of our mostly healthy five-year-old. Prior to reading your articles it was more of a belief that putting many non-FDA supplements into his body with the occasional prescription from his pediatrician couldn’t be a good thing. The irony I have found is highly qualified pediatricians won’t or can’t comment on non-FDA drugs while the naturopath is more than happy to talk about what pediatrician prescribes plus what supplements are needed instead or in addition to.
Some therapies like meditation, which are often categorized as “alternative” or “complementary” medicine, may be helpful, and have some scientific evidence to back them up. Others are the sorts of things drawn from the canons of traditional and alternative medicine and are essentially harmless—like hydrotherapy, where patients are treated using water at different temperature and pressure, and massage therapy. But there are also many pseudoscientific treatments that lead patients into positions of great risk, including ozone therapy, which involves injecting or breathing ozone, a toxic gas made up of three atoms of oxygen (instead of the two-atom version of oxygen keeping us alive), and treating cancer with substances like baking soda, vitamin C, and other products that have been shown to have no effect.
Lumping all these types of therapies under the umbrella of naturopathy makes it difficult for patients to understand what is backed by scientific evidence and what isn’t. “Incorporating magical thinking into the realm of evidence-based medicine is both ethically questionable and professionally irresponsible,” researcher and journalist Alheli Picazo wrote about the Stephens case in 2016. In the end, most patients simply believe whatever the naturopath has to say.
Within days of finding out that Ukrain was not FDA approved, Hermes got a lawyer. She was worried that she may have been an accessory to a crime. The lawyer assured Hermes that she was safe, because she delivered Ukrain under her boss’s direction and without knowing then that the drug was unapproved. That gave her the confidence to do something about the guilt she was feeling about mistreating her patients.
“I was willing to do whatever it took to correct the wrong”
“I was willing to do whatever it took to correct the wrong,” Hermes says. She reported her boss, Michael Uzick, to the Arizona Naturopathic Physicians Medical Board and to the state’s attorney general. She also began auditing the websites of other naturopaths and realized that the use of unapproved drugs and therapies was widespread. “I was really shocked,” she recalls. “But it also felt like a lightbulb went on. It suddenly became so obvious to me that I was amazed I had missed it.”
“I needed to decide whether or not I could go back into naturopathy knowing that a number of my colleagues are blatantly breaking the law and putting patients’ lives at risk,” Hermes says. She didn’t have to struggle with the question for long. The naturopathic board did nothing more than reprimand Uzick. The attorney general never took up the case, but passed it on to the Federal Bureau of Investigation, which has not yet replied to Hermes.
Uzick, through his lawyer, says that the reprimand “did not result from any patient complaint, but from accusations made by a disgruntled practitioner who worked with Dr. Uzick and understood his treatments, and made no complaint until she abruptly left the practice.”
When she saw the case be tossed liked a hot potato from the board to the Arizona attorney general to the federal FBI, Hermes felt her moral choice couldn’t be clearer.
A NEW START
After Hermes stopped her practice in 2014, life’s other mundane, but unavoidable, problems became apparent. She had racked up a debt of more than $250,000 for her Bastyr degree, and needed a source of income to pay back the loan or risk letting interest pile on. She had also fallen in love and gotten married. When her husband was a offered a place to study for a PhD in archaeology at a university in Germany, it felt like an opportunity for a fresh start.
That’s when, in late 2014, she discovered the story of Edzard Ernst, author of Trick or Treatment? Alternative Medicine on Trial, written with science journalist Simon Singh. “I lived with the book on my bedside table for six months,” Hermes says. “It got me through a really difficult period.”
Ernst trained as a doctor and then learned homeopathy at a hospital in Germany. He would, like Hermes, turn on his profession, showing through his own peer-reviewed research how homeopathy was nothing more than a placebo. As someone who also stopped practicing alternative medicine and began speaking against it, he saw a bit of himself in Hermes. That’s why he encouraged her to blog.
“I remember putting up my first blog post and being overwhelmed with anxiety,” Hermes says. “I wanted people to read my words, but I was so afraid of what they would think. I felt exposed. I cried a lot.” After the Ukrain revelations, Hermes developed intense anxiety, and was eventually prescribed medication for the ailment. Blogging brought similar anxiety and she went back on the meds.
“I’ve found myself in grocery stores not knowing whether to buy organic bananas or regular ones,” Hermes says. “I find it upsetting that I don’t know how to navigate my life any more. It’s a product of living in a culture of misinformation for a very long time.”
Subject: Thanks for what you are doing!
I know the courage it has taken you to speak out about the fallacies of naturopathic medicine. I taught at a naturopathic college myself, so I know first hand that every thing you are saying is true. I have much admiration for you. Keep up the good work.
For the past few years, after realizing she had been swindled in her education, Hermes has waged a war on naturopathy. On blogs and in online publications, she has opened a window into a profession that resists external scrutiny of its training and practices.
“These schools of quackery operate like cults”
“A conversion story like hers is rare,” says David Gorski, managing editor of the non-profit, online publication Science-Based Medicine, which was among the first few places to publish Hermes’s writing. The choice of the word “conversion” is a deliberate swipe at alternative medicine, which Gorski says is more like a religion. Ernst says the schools are, in part to blame. “These schools of quackery operate like cults,” he says. “People are being brainwashed with books, by peers, through media and so forth.”
Bastyr is a nonprofit and private university that was founded in 1978, near Seattle. Its founders named it after John Bastyr, a naturopathy practitioner based in the city. Today, it offers undergraduate, master’s, and doctoral programs to its 1,000 students, but these are not accredited by the same body that accredits US medical schools. Instead, a council of naturopaths oversees the programs. Bastyr says its courses are are also accredited by the Northwest Commission on Colleges and Universities.
Bastyr now wants to keep Hermes, who has become a warrior for the truth, from speaking out. It’s an uneven fight from the start: a university with deep pockets against a student with huge tuition loans to pay off. (In response to questions from Quartz, Bastyr University says there are no updates to report since its July 21 letter to Hermes.)
“It’s an occupational hazard,” says Steven Novella, founder of Science-Based Medicine. “When we expose quacks and cranks, it’s no surprise we get personally attacked.” In 2014, Novella was sued by Edward Tobinick, a doctor claiming to treat neurological diseases with a drug that wasn’t approved for it, because Novella exposed Tobinick’s unsubstantiated claims. After two years of trial and appeals, Novella won the case but is yet to receive the tens of thousands of dollars he had to spend in legal fees to defend himself.
Separately, Ernst and Singh were each legally threatened by two different organizations promoting alternative medicine. Though Singh won a landmark libel case, Ernst was forced to retire early from his job as a professor of complementary medicine at the University of Exeter, after finding himself unable to acquire the grants needed to continue research. Now it’s Hermes’ turn.
Subject: Thank you
I was about halfway through naturopathy school when I started having doubts about the profession again. I had been searching for a while to find the opinion of someone who had graduated and left the field, and when I found your blog I felt an amazingly strong sense of relief and joy to be able to read what you had written and relate to all of it. I only wish that I had read your blog before starting!
Each individual has to decide for themselves, but skeptics say these fights are always worth fighting. Each voice is unique and necessary, and each voice lost is a huge blow to the skeptic mission. On her blog, Hermes has separate resources section for patients, students, lawmakers, and journalists. She has a section where former or current naturopaths, patients, and healthcare workers who’ve experienced naturopathy can submit guest posts. “It is important for more voices to be heard,” she writes.
And the feedback she receives from readers, including medical doctors and patients looking to use naturopathy, reminds her she is doing the right thing and gives her the motivation to continue. (We’ve reproduced some of these emails, interspersed throughout this article.) Some praise her for being “brave”; others thank her for giving “the final push” needed to quit studying naturopathy; most are simply grateful for having Hermes speak when they themselves couldn’t. Her testimonies have been crucial in defeating two proposed legislations—one in North Dakota and another in California—which would have increased the power of naturopaths, from prescribing pharmaceutical drugs to practicing midwifery.
Subject: Hi Britt
I was in your class at Bastyr. I found attempting to practice naturopathic medicine a nebulous, daring venture. I absolutely did not feel qualified to be anyone’s physician. After such a huge investment in time, money, and energy, it took me a while to truly accept that I want to find another career path. It is nice to know there are others who feel as though their training was less than sufficient.
When Hermes was training to be a naturopath, the evidence against alternative medicine was easily available. But she was surrounded by believers and was personally invested in the success of naturopathy, so she found ways to dismiss any creeping doubts. It was only when she had a “crisis of conscience,” as Gorski describes the Ukrain episode, did she open up to contrary evidence. That was her moving from inside the cult to the top of the fence.
She found the evidence she needed to jump most easily in Trick or Treatment. “What Ernst and Singh were able to do so beautifully was provide information that felt nonjudgmental,” Hermes says. “I didn’t feel like I was being put down for having used naturopathy or having been a naturopath.”
“Everything I had read prior to Trick or Treatment about naturopathy from a critic’s perspective was written in such a way that it was impossible for me to digest the information,” she says. “As soon as I read the word ‘quack’ or ‘pseudoscience’ I couldn’t get anything from the article.”
The book’s matter-of-fact approach to debunking naturopathy influenced Hermes’s thinking on naturopathy. But her own persistence mattered too.“I certainly have a propensity for magical thinking and alternative medicine,” Hermes says. “Even now, whenever I get sick with cold, my first response is ‘I don’t want to take any medication,’” Hermes says. That’s why it helped to have a guide like Trick or Treatment on her bedside. “Every time I felt like maybe I shouldn’t be giving up naturopathy, I opened the chapter on naturopathy and stopped myself from making that decision.”
Today, Hermes says that when she writes, even if using the same material that’s readily available to anyone with internet access, she is able reach a bigger audience. “My training as a naturopath adds credibility to my claims,” she says.
Hermes is becoming a sought-after speaker at events organized by the skeptics community. Hearing a former naturopath helps other skeptics understand better how to reach their target audience. “Everyone knows someone who has tried alternative medicine,” Hermes says. “My advice to these people is don’t bombard them with information about how naturopathy doesn’t work. Instead, listen to why they believe in naturopathy, ask open-ended questions, understand their perspective, and then go from there.”
Going through her story again and again at these speaking events is painful. “I’m putting myself through torture every time I relive those memories,” Hermes says. Though she gets plenty of positive feedback, she receives a lot more hate mail. And for someone who has been through a great deal of change in her life, existential questions are a daily problem.
“Will it have a made a difference if I continued to do this for 25 years? Will I ever be able to convert people inside the cult?” Hermes says. “I ask these questions all the time, and I don’t yet have answers.”