Science-Based Medicine vs. Science-Based Natural Medicine [Rationality, UTTER Nonsense - Respectively]:

here, I compare two schools of thought or movements [see 004., below regarding these loose expressions], Science-Based Medicine [SBM; see 001., below] and supposed Science-Based Natural Medicine [SBNM; see 002., below] in terms of their mutual claims of being scientific, and then I expose the one that is UTTER NONSENSE [see 003., below]:

001. according Dr. Stephen Novella in "Announcing the Science-Based Medicine Blog" at the blog "Science-Based Medicine", SBM:

"[promotes] the highest standards and traditions of science in medicine and health care. The mission of this blog is to scientifically examine medical and health topics of interest to the public [...] it is in everyone’s best interest for health care to be systematically evaluated by the best science available [...] science is nothing more than a systematic and careful use of evidence and logic to evaluate factual claims [...] good science possesses certain virtues that are not unique to science but generic to all intellectual endeavors: fairly accounting for all available evidence, using valid and internally consistent logic, using unambiguous concepts and language, proper use of statistics, being quantitatively precise and accurate, and above all being honest [{intellectual integrity}...] collectively, science builds one cumulative model of the natural world. This means we can make rational judgments about what is likely to be true based upon what is already well established. This does not necessarily equate to rejecting new ideas out-of-hand, but rather to adjusting the threshold of evidence required to establish a new claim based upon the prior scientific plausibility of the new claim [...] this is why the authors of this blog strongly advocate for science based medicine – the use of the best scientific evidence available, in the light of our cumulative scientific knowledge from all relevant disciplines, in evaluating health claims, practices, and products."

Note: SBM aims for "the highest of standards", per "the best science", intellectual integrity, AND cumulative & rational investigation of the natural world based upon prior plausibility [in other words, 'extraordinary claims demand extraordinary evidence']. This sounds to me like a very good thing.

002. regarding SBNM:

002.a. according to the leading proponent of SBNM, J.E. Pizzorno, ND (NCNM 1975):

"Joseph E. Pizzorno, Jr., N.D. [JEP...] is one of the world's leading authorities on science-based natural medicine [per his credentials as] a naturopathic physician [...] he travels worldwide, consulting, lecturing and promoting science-based natural medicine [...he has been honored for his] 'decades of work establishing the scientific and educational foundation of natural medicine' [...] Dr. Pizzorno is the author of Total Wellness [TW] and co-author of the internationally acclaimed Textbook of Natural Medicine [TNM]."

Note: the claim is that being a naturopath is equivalent to being an expert practitioner of the "science-based" because naturopathy supposedly is "science-based natural medicine". This position is also found at the ND granting school Pizzorno founded, Bastyr University, which claims:

a) at their web page "About Us [concerning Bastyr's programs]":

"Bastyr.edu is a science-based natural medicine university [...] Bastyr University is a non-profit, private university offering both graduate and undergraduate degrees, with a multidisciplinary curriculum in science-based natural medicine [...] Bastyr’s international faculty teaches the natural health sciences with an emphasis on integrating mind, body, spirit and nature."

b) in their Peterson's.com advertisement:

"Bastyr University School of Naturopathic Medicine [...] Bastyr's fully accredited four- to five-year Doctor of Naturopathic Medicine (N.D.) program is internationally renowned for its rigorous, science-based curriculum. Combining a distinct multidisciplinary, science-based approach to teaching with an emphasis on understanding the mind, body, spirit, and nature [...] students receive a thorough foundation in the basic medical sciences [...naturopathy is within] the field of natural health sciences [...we create] scientifically trained naturopathic physicians."

Obviously, [Pizzorno's] Bastyr claims that the naturopathic is scientific; and by definition, Bastyr claims that SBNM is science. Also, notice that Bastyr claims that the supernatural is science, as well as what they term "nature" [see 002.c2. below, where I expose what "nature" is within naturopathy].

Obviously, Dr. Pizzorno claims to excel at "science", and Bastyr claims the same. It should be noted that Pizzorno does not apparently possess science credentials in any significantly meaningful sense per 'high echelon academia' [I'll call it], and anyone or any institution who/that establishes the scientific basis of what is 'the essentially naturopathic' [vitalism, spiritism-supernaturalism, cosmic teleology & other science-ejected kind] would upend several hundred years of scientific advancement to such an extent that I'd at least think by now Nobel Prizes would have been awarded. After all, the NDs have been formally claiming that vitalism and their other beliefs [spiritism, cosmic teleology] survive scientific scrutiny since at least 1989 with the unanimous ratification of their creed at Rippling River! But, no such because instead of actually producing scientific verification of their claims through the channels that science requires, NDs merely write words and posture their claims as science without producing the actual EXTRAORDINARY evidence needed to establish the hugely/profoundly nonscientific as indeed scientific -- and this racket/farce of SBNM has been feeding the ND luminaries $$$ for at least a couple decades].

002.b. I'll reiterate these facts, before I go on:

JEP is a graduate of National College of Natural Medicine [NCNM], 1975. NCNM is the oldest North American ND school, and the trunk of the ND tree so to speak. JEP is the author of the primary North American ND textbook, the TNM.

002.c. naturopathy claimed as science while based upon vitalism [a vitalism, spiritism, teleology amalgam] / a.k.a. the science-ejected -- what TW, TNM, and NCNM tell us:

002.c1. naturopathy claimed as science:

002.c1.a. in TW, JEP states on its dust jacket (ISBN 0761504338; 1996):

"Joseph Pizzorno, N.D., co-author of A Textbook of Natural Medicine and Encyclopedia of Natural Medicine, is one of the world’s leading authorities on science-based natural medicine [...this book is] grounded in scientific research [...and speaks of] the body's potent, innate healing systems [{in the book, one of those systems is the 'life force'; see 002.c2.a., below} p. xi]."

Note: and in the preface, JEP writes: "I have used and taught the concepts in this book for 25 years [...and] I reviewed the scientific literature for the latest research." In chapter one, we're told by JEP: "all the information in this book is fully referenced to the scientific research literature [p.006]."

002.c1.b. in TNM, co-author JEP states in "Preface" and "Chapter 3" (ISBN ISBN0443059454; 1999):

"[along my ND Murray] the scientific support for the philosophical and therapeutic foundation of natural medicine has evolved remarkably over the past 25 years [p.xxviii...along with ND homeopath Bradley] while modern vitalism is inherently holistic in its view and has an emphasis on circularity as its causality (i.e. feedback loops), there is no conflict with the findings of biomedical science [p.044...] the point is only that vitalism is a medical philosophy based on observable scientific phenomena [p.045...] conventional medicine, as the dominant health care system and a representative of mechanism, has claimed for itself the title of 'scientific medicine'. However, it is inherently no more or less scientific than vitalistic medicine [...] the criteria of the scientific method can be met by vitalistic medicine, but only when the researchers recognize that it cannot be studied as though it is reductionistic or based on a simplistic model of linear causality. When the experimental model acknowledges the complexity of a living system in a social context (i.e. holism and circularity), vitalistic medicine proves to be both verifiable and reproducible, and thus scientific [p.046]."

Note: so, vitalism is science [only when the strictures of science are annulled!].

002.c1.c. NCNM states in "Principles of Healing":

"the practice of naturopathic medicine emerges from six principles of healing. These principles are based on the objective observation of the nature of health and disease and are examined continually in light of scientific analysis [...and later they state that the essentially naturopathic is] in fact."

002.c2. naturopathy's essential vitalism [the context of its "nature" or its "innate healing systems"]:

002.c2.a. per TW, JEP states:

"[remember these] important concepts. The healing power of nature [HPN]. Vis medicatrix naturae [VMN]. Our bodies have a tremendous ability to heal [...] natural healers refer to this inherent drive as 'the healing power of nature' or the vis medicatrix naturae [p.003...you need to] live in harmony with your life-force [LF...such is a] belief [...a] spiritual value [...] each of us needs to become more aware of the activity of the vis medicatrix naturae (life-force) [p.026...] seven underlying, health-sustaining systems of our body must function effectively to ensure our well-being, prevent disease, and allow a full life: the immune system, the detoxification system, the inflammatory system, the metabolic system, the regulatory system, the regeneration system, and our life-force or spirit [S]. Weakness in any of these seven systems results in susceptibilities that allow most common diseases to develop [p.024...] live in harmony with the psychosocial [PS]/spiritual/ life-force [p.317...] the life-force within each of us, which naturopathic physicians call the vis medicatrix naturae [...it is] this teleological force [TF], the healer within [THW], that is the essence of each of us [p.333]."

Note: so, HPN = VMN = LF = S = PS = TF = THW. This is naturopathy's essential vitalism [vitalism, spiritism, teleology], and such is [falsely] claimed to be science. Why a "life force" or "spirit" equals the "psychosocial" is beyond me.

002.c2.b. TNM states in "Chapter 06 - Philosophy of Naturopathic Medicine":

"[a chapter ascribed primarily to ND homeopath Bradley] this chapter examines the philosophical foundation of naturopathic medicine [...] the foundations of naturopathic medical philosophy are found in vitalism [...] the philosophy of vitalism is based on the concept that life is too well organized to be explained simply as a complex assemblage of chemical and physical reactions [...he claims] vitalism is a medical philosophy based on observable scientific phenomena."

Note: again, the essentially naturopathic is vitalism, which is claimed to be scientific.

002.c2.c. NCNM states in "Principles of Healing":

"these principles stand as the distinguishing marks of the profession: the healing power of nature -- vis medicatrix naturae. The body has the inherent ability to establish, maintain, and restore health. The healing process is ordered and intelligent [teleological]; nature heals through the response of the life force. The physician’s role is to facilitate and augment this process [...] first do no harm -- primum no nocere. The process of healing includes the generation of symptoms, which are, in fact, expressions of the life force attempting to heal itself. Therapeutic actions should be complementary to and synergistic with this healing process [...naturopathy is] the practice of promoting health through stimulation of the vital force."

Note: so, at JEP's alma mater, HPN = VMN = LF = VF. AND, NCNM claims on this page that vitalism survives scientific scrutiny - such is an obligation of an NCNM ND and particularly an ND practicing in Oregon by .gov decree! Along the same lines, a Bastyr ND is obligated to a similar absurdity merely in different language. Notice also the claim of meeting the ethical strictures of professionalism.

003. ohhhh, the OBVIOUS nonsense that is SBNM [because vitalism is hugely not science, along with supernaturalism & teleology - 'something is not equal to that which it is hugely different from, and excludes']:

there actually is no science basis for what is essentially 'the naturopathic'.

Though claimed as science, naturopathy at its core is actual science-ejected: vitalism is hugely science-ejected, and so is supernaturalism [teleology as well].

004. on 'school of thought' and 'movement':

004.a. school of thought:

Wikipedia states in "School of Thought":

"a school of thought is a collection or group of people who share common characteristics of opinion or outlook of a philosophy, discipline, belief, social movement, cultural movement, or art movement."

Note: I would say that SBM fits the loose definition of a school of thought. But, SBNM isn't much into thinking at all, when you consider its falseness and nonsense -- to be elevated to the status of 'academically soundness'. I'd rather term SBNM as school of idiocy, incompetence and dishonesty.

004.b. movement:

Wikipedia states in "Movement":

"philosophical movement, is either the appearance or increased popularity of a specific school of philosophy, or a fairly broad but identifiable sea-change in philosophical thought on a particular subject."

Note: I would argue that SBM is mainstream and quite mundane scientific movement, while SBNM is a cultic / sectarian philosophical/intellectual RUSE that is quite nonsensical, incompetent & dishonest.

To the extent that SBM is 'philosophical', it promotes the priority of a posteriori empirical knowledge [which includes science]; while SBNM / naturopathy is a pile of a priori beliefs falsely labeled science [pseudoscience; and quite an abuse of the institutions of education, physicianship, and professionalism overall -- to such an extent that I regard it as a human rights violation to the extreme].

Homeopathy - WHO Says No to Such "Dangerous Quackery", UB Naturopathy Says Yes:

here, I look at two positions which are quite at odds regarding homeopathy -- a mandatory ND subject area for the degree, labeled a "clinical science" on their NPLEX licensing exam -- that of a proponent of scientific medicine [see 001., below], and that of an ND degree granting CT institution that falsely labels the profoundly nonscientific as science (specifically naturopathy and its 'essentially naturopathic' contents, such as homeopathy) [see 002., below]:

001. at Neurologica, Dr. Stephen Novella states in "WHO Says No to Homeopathy" (2009-08-21):

"the World Health Organization [WHO], which does not have a good track record when it comes to pseudoscience in medicine (being too much of a political organization), has recently made a number of statements against the use of homeopathy [...] this is good news, as homeopathy is dangerous quackery."

Note: Dr. N. further describes homeopathy as:

a) "a pre-scientific philosophy that it is based entirely on magical thinking and is out of step with the last 200 years of science";

b) "literally nothing but pure magical thinking";

and Dr. N. states:

c) "[homeopaths] want to re-frame the conflict between scientific medicine and homeopathy so that it is not about science (since they have already lost the scientific war) but about culture, politics, and ideology [...] homeopaths are much better at that than scientists who are dedicated to honesty and transparency."

002. but, according to the naturopathy establishment, e.g. the University of Bridgeport College of Naturopathic Medicine [UBCNM] even though homeopathy is a "pre-scientific [...] dangerous quackery [...] based entirely on magical thinking":

002.a. it is required within an ND degree and labeled "medicine";

002.b. and, since within UB's label of naturopathy as science overall, homeopathy is labeled therein science;

Note: so, when is a supposed "medical science" actually not science at all but instead junk falsely labeled science?

Yes, naturopathy.

Explaining Without Explaining: Naturopathy's CODED Central Premise Via Lane, K. (NMD SCNM):

here, I show a typical ND / NMD ruse -- via Kiera Lane NMD -- presenting in naturalistic language [see 001., below] an actually sectarian science-ejected premise [see 002., below]:

001. Kiera Lane, an NMD graduate of Southwest College of Naturopathic Medicine [SCNM] states in "Philosophy":

"what are the [essential] principles of naturopathic medicine? 1. Healing power of nature [HPN]: naturopathic physicians utilize the healing power of nature to facilitate the body’s own healing process. Their role is to facilitate and augment this process by identifying and removing obstacles to health and wellness."

Note: and that's all you are told. Can you make an informed decision based on this? No, and I'll tell you why not [you have to know what they are coding in order to understand that they are masking their sectarian science-ejected central premise].

002. the actual context of HPN, via that "Dr.'s" alma mater, SCNM:

002.a. SCNM states in "Is Alternative Medicine For You?":

"the healing power of nature [...] first described in western medicine by Hippocrates, the vis medicatrix naturae, is also referred to as chi in Chinese medicine, prana in ayurveda, and vital force in homeopathy. When alive, the vis medicatrix naturae enables humans and other living beings to resist entropy and decay, unlike inanimate objects that are subject to these effects. Creating treatment plans that harness the healing power of nature [...] the essence of naturopathic medicine."

Note: this is vitalism, essentially.

002.b. and, vitalism is hugely science-ejected.

003. would you know that from the "Dr.'s" web page? No. And, being that the "Dr." describes herself as a "medical director", isn't medicine ETHICALLY obligated to the INTEGRITY of its scientific knowledge and not misleading its patients?

Note: fascinating. I got thousands more ND sites like this.

Life U.'s Vitalism Woo Per D.C. & Dr. Hall on Science Per S.I.:

here, I quote from a recent Dynamic Chiropractic article by the President of Life University that describes chiropractic's vitalism [see 001., below]; and, then a recent Skeptical Inquirer article by Dr. Harriet Hall that offers some advice regarding skeptics' engagement with such woo [see 002. & 003., below]:

001.a. Life U. President Riekeman states in "Vitalism Key to Contemporary Health Care Policy" (Dynamic Chiropractic; vol. 27, no. 17):

"vitalism [...] the idea of a spirit that animates and operates the body [...a.k.a.] biological vitalism [...a.k.a.] the body as a self-regulating system [...this] inherent self-maintaining, self organizing and self-healing ability of the body [...a.k.a.] vis medicatrix naturae [...is] the new vitalism [...] a truly vitalistic approach to national health care [is needed...per a] chiropractic approach to health [...] 'vitalism is a good paradigm' [...] vitalism provides the right framework through which chiropractic can provide a truly meaningful contribution [...our] vitalistic wellness philosophy [...] our vitalistic philosophy [...] our vitalistic approach to health."

Note: Life U. defines itself as vitalistic. It is also steeped in subluxation theory. Subluxation theory is not scientifically supported. Upon reflection, vitalism is an archaic superstition. Overall, vitalism and subluxation theory are as scientific as the Tooth Fairy, and she ain't a solution for any kind of dental problem in the same way vitalism and subluxation theory aren't gonna solve real-world health care issues.

Particularly in terms of this blog's mission to discuss naturopathy mainly, a spirit running the body -- vitalism -- is an article of faith / supernaturalism / sectarianism, and such implausible suspensions of the laws of nature do not have scientific support. It is a HUGE logical error to claim that such a sectarian belief is the same thing as the ability of the body to heal and regulate itself, because biology-physiology is scientific and naturalistic and vitalism is the opposite. That is simply a fact. The new vitalism is just old sectarian wine relabeled in vagarity.

001.b. the Life Source Octagon think tank states in "Vis Medicatrix Naturae":

"Vis Medicatrix Naturae [...is] a historic set of presentations and discussions on the new vitalism. Representatives of chiropractic, naturopathy [I'm fascinated by naturopathy's essential vitalism], Asian medicine, ayurveda medicine and homeopathy will discuss vitalism [...e.g. per naturopathy] Vitalistic Philosophy - Naturopathy. Joseph Pizzorno, ND. Past President, Bastyr University and author of Textbook of Natural Medicine [TNM]."

Note: the chapter on vitalism in the TNM is most amusing. One of my favorite errors is the very wrong claim that life defies thermodynamic law. Vis medicatrix naturae is, of course, HUGELY naturopathy's vitalistic premise. I guess chiro. is getting tired of Innate.

002. Dr. Hall states in "Playing by the Rules" (Skeptical Inquirer; 2009-05/06):

"[advice] it is useless for skeptics to argue with someone who doesn’t play by the rules of science and reason. If no amount of evidence will change your opponent’s mind, you are wasting your breath [I so much agree...] science has been a very successful self-correcting group endeavor. It wouldn’t be successful if it didn’t follow a strict set of rules designed to avoid errors [...] if proponents of intelligent design or alternative medicine [like naturopathy,chiropractic, homeopathy] want to play the science game, they ought to play by the rules. If they won’t play by the rules, they effectively take themselves out of the scientific arena and into the metaphysical arena. In that case, it is useless for us to talk to them about science."

Note: regarding vitalism, remember that Bechtel and Richardson state that today vitalism "is often viewed as unfalsifiable, and therefore a pernicious metaphysical doctrine [...and according to Keating in that same article] 'chiropractors are not unique in recognizing a tendency and capacity for self-repair and auto-regulation of human physiology. But we surely stick out like a sore thumb among professions which claim to be scientifically based by our unrelenting commitment to vitalism ['the how that happens' explanation for that self-repair / auto-regulation]. So long as we propound the 'one cause, one cure' rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways [nor can NDs!]. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers' Innate [naturo. has this as well, as purposeful & intelligent 'vital force'] should be rejected' [hear, hear...and quoting Williams] 'today, vitalism is one of the ideas that form the basis for many pseudoscientific health systems [naturopathy, chiropractic, homeopathy & kind] that claim that illnesses are caused by a disturbance or imbalance of the body's vital force'".

003. what sCAM woomeisters have failed to do according to Dr. Hall, and some advice:

"there’s no point in arguing scientific facts with someone whose worldview is metaphysical [e.g. vitalistic] and nonscientific [e.g. supernaturalistic...] if they won’t play the science game by the rules, we are justified in crying 'foul' and disqualifying them [...] wouldn’t it be refreshing to hear a homeopath [or a chiropractor or a naturopath] say, 'I believe homeopathy [or naturopathy or chiropractic] works based on my personal experience and on nonscientific evidence like testimonials, and I categorically reject the results of any scientific trial that fails to support my beliefs' [a.k.a. 'I'm a health sectarian'...] if they'd say that up front, we wouldn't waste any of our valuable time rehashing scientific evidence [or lack thereof] that they will just ignore. They would be out of the game, permanently. And patients would have a better basis for giving truly informed consent."

Note: yup.

AANP's Science Label Upon 'Naturopathy the Nonscience' - Snailmail Booklet 2009, Mail Fraud [USPIS]:

here, I detail the absurd claim by the American Association of Naturopathic Physicians [AANP] that, overall, naturopathic medicine / naturopathy is science [see 001., below]; I point out that they are coding their essential vitalism in this booklet [see 002., below]; and that such vitalism is actually hugely science-ejected [see 003., below]; and, amidst all this pseudoscience opacity, I wonder about mail fraud and further ramifications [see 004., below]:

001. the AANP states in the paper-based booklet "Naturopathic Medicine: Primary Care for the 21 Century":

"naturopathic medicine is distinguished by the principles that underlie and determine its practice. These principles are based on the objective observation of the nature of health and disease, and are continually reexamined in the light of scientific advances [...] students of naturopathic medicine learn the medical sciences as a foundation [...] the first two years of ND training concentrate on the basic biomedical sciences [p.007...] the second two years integrate the basic biomedical sciences with the clinical sciences [p.008...] a growing body of scientific research supports the efficacy and safety of various herbs for preventing and treating many health conditions [p.009...] a growing body of scientific literature points to the interrelationship of the mind, body and spirit [...per] a holistic approach [p.009...] naturopathic medicine addresses the need to hold its physicians and organizations accountable to the public for safety and efficacy through a variety of well-accepted mechanisms that are common to all the regulated healthcare professions [...] Naturopathic Physicians Licensing Examination (NPLEX) [...] NPLEX prepares a series of sixteen examinations (five basic sciences and eleven clinical sciences) [...] the NPLEX Part 1 - Basic Science Examinations (BSE) are comparible to the basic science examinations in other health care professions [...] the NPLEX Part II - Core Clinical Science Examinations (CSE) [...] the NPLEX Part II - Clinical Science Add-on Examinations [...include] homeopathy [p.011...] naturopathic physicians cooperate with all other branches of medical science [...] the naturopathic medical colleges and professional organizations are committed to scientific evaluation of the medicine [p.013]."

Note: their is an overarching claim to being HUGELY science, scientific, medical science, basic biomedical science, and clinical science -- and of the professions in ethicality.

002. coded science-ejected vitalism. Nowhere in this document are we informed that naturopathy is indeed vitalistic / based on vitalism. NOWHERE [pseudoscience opacity]. Instead, we're told:

"six powerful concepts provide the foundation that defines naturopathic medicine [...#1] the healing power of nature: trust the body's inherent wisdom to heal itself [p.008...] homeopathy [{which shows up in this document at least 16 times}...] stimulates the body's own natural healing forces for recovery [p.009...plus we get some supernaturalism in] treat the whole person: view the body as an integrated whole in all its physical and spiritual dimensions [p.008]."

Note: since when does a supposed profession not disclose its essential context? How is one to have 'informed consent' type rights when the supposed profession is not coming clean with the public?

003. vitalism is hugely science-ejected, and so is supernaturalism.

oo4. regarding mail fraud:

004.a. Wikipedia states in "Mail Fraud":

"mail fraud is an offense under US federal law, which refers to any scheme which attempts to unlawfully obtain money or valuables in which the postal system is used at any point in the commission of a criminal offense. Mail fraud is covered by Title 18 of the United States Code, Chapter 63."

004.b. the United States Postal Inspection Service states in "Mail Fraud Compliant":

"the form below allows you to send a complaint to the U.S. Postal Inspection Service if you suspect you are a victim of mail fraud [...] the Postal Inspection Service [...] can act against a company or individual if there is a pattern of activity suggesting a potential scheme to defraud. Completion of this form is voluntary, but the more information that you enter, the better the Postal Inspection Service may be able to help [...] we may share the information you provide with other agencies when a possible violation concerns their jurisdiction [...] you may also go to the Federal Trade Commission site for more information."

Note: I bought this brochure from AANP for about $18 and it was sent to me by U.S. Mail from Washington, D.C. I got falsehood: a claim of science upon what is not science. Now, imagine if I engaged with naturopathy as an education consumer, and ended up with six-digit student loan debt due to such pseudoscience opacity! [Hey, that's me].

This document states: "the naturopathic profession calls upon state and federal healthcare policymakers and regulators."

PAC-wise, naturopathy has been HUGELY successful.

Look at Oregon.gov's OBNE: complete naturopathic nonsense stated as able to survive scientific scrutiny -- legislated, with a .gov endorsement -- all the while claiming to protect the public.

Hugely professional.