Tuesday, March 29, 2016

The Naturocrit Podcast - s02e02b1 [Episode 012b1] - Script & Annotations

here, I provide an annotated script for first part of Part Two of Episode Twelve of The Naturocrit Podcast.  I cover the ABIM "Physician's Charter" and reporting on the Ezekiel Stephan trial:

001. the Episode 012b1 script and annotations:

Standard Introduction:

Welcome to, as that robot voice says, The Naturocrit Podcast, and thank you for boldly listening.

What ARE we even talking about?

Well, this podcast series is my take on naturopathic medicine, an area I've been studying for about twenty years, including my time in so-called 'scientific nonsectarian naturopathic medical school'.

My approach is a pairing of scientific skepticism and a deep knowledge of naturopathy's intimate details.

In previous episodes of this series, I established that naturopathy is, essentially, a kind of knowledge blending, misrepresentation, and irrationality.

I have termed naturopathy both 'an epistemic conflation falsely posing itself as an epistemic delineation' and 'the naturopathillogical':

the science-exterior is mixed with what is scientific, then that whole muddle is absurdly claimed to be science as an entire category, while particular sectarian science-ejected oath-obligations and -requirements are coded or camouflaged, therein effectively disguising naturopathy's system of beliefs in public view.

Naturopathy's ultimate achievement is a profound erosion of scientific integrity and freedom of belief packaged in the marketing veneers "natural, holistic, integrative and alternative"and improperly embedded in the academic category "science".

Episode Synopsis:

In this Naturocrit Podcast Episode 12, aka s02e02, titled "Preponderant and Universal Medical Ethical Codes and North American Naturopathy's Transgressions", I'll be looking at modern medicine's ethical commitments, and comparing those stringencies to naturopathy's 'anything goes' laxity.

In this Part Two, I'll be looking at two medical ethical codes, the ABIM's in Part One of this Part Two, and in Part Two of this Part Two, the AMA's.

Main Text:

Before I get into the American Board of Internal Medicine's “Physician's Charter”, which MD Atwood cited from twelve years ago in his 2004 article, let me tease something that, in light of what I've already revealed about naturopathy, might NOT come across as shocking:

naturopathy's CURRENT, unphased, 'batshit crazy illogic'.

The Minnesota Association of Naturopathic Physicians, and I'll be returning to the example of MNANP in a future part of this episode, tells us in their homepage (2016 archived):

“the Minnesota Association of Naturopathic Physicians (MNANP) is the professional organization for naturopathic doctors in Minnesota […] the mission of the MNANP is to protect and modernize naturopathic doctor's scope of practice, support strong professional standards for our members, increase public awareness of and access to natural and integrative medicine throughout the Midwest […we are] experts in natural medicine: naturopathic medicine is an advanced degree health care profession that, through a comprehensive understanding of conventional and natural medicine treatment options, emphasizes the ability of the human body to heal or achieve balance, naturally […] the healing power of nature. Naturopathic doctors combine the wisdom of nature with the rigors of modern science. Steeped in traditional healing methods, principles and practices, naturopathic medicine focuses on holistic, proactive prevention and comprehensive diagnosis and treatment. By using protocols that minimize the risk of harm, naturopathic doctors help facilitate the body’s inherent ability to restore and maintain optimal health. It is the naturopathic doctor's role to identify and remove barriers to good health by helping to create a healing internal and external environment […] doctors who listen. A naturopathic doctor is trained to: diagnose disease, investigate the underlying cause, understand conventional and naturopathic treatment options, promote healing in the human body, utilize other health care professionals, provide integrative health care [...] holistic healthcare: a naturopathic doctor will take time with you. During your first appointment, your doctor will take your health history, find out about your diet, stress levels, use of tobacco and alcohol, and discuss why you’re there. He or she may perform an examination and order diagnostic tests. Naturopathic doctors keep themselves up-to-date on the latest scientific research and incorporate this evidence into their treatments. The naturopathic doctor will work with you to set up a customized health management strategy. If necessary, your doctor will refer you to other health-care practitioners [...and we're told MNANP is an] affiliate of the American Association of Naturopathic Physicians.”

THERE are promises of:

profession, protection of naturopaths, expansion of naturopathy, strong professional standards, public awareness, natural and integrative, expertise, advanced health care degree, comprehensive understanding, coded vitalism, blending of science and nonscience, traditional, holistic, diagnosis and treatment, coded vitalism again, listening, and scientifically-up-to-date.

REALLY.

What's the point in "keeping[ing] themselves up to date on the latest scientific research" if you then take that 'good stuff' and deliberately "combine" it with nonscientific junk?

That is, as I've termed it, 'epistemic conflation.'

Minnesota naturopathy PROMISES to be blending or incorporating or "combining" science with other things, other things they DON'T mention except in a coded manner above, like all the naturopathic junk I mentioned in Part One of this Episode.

But, THEN we get a FALSE CATEGORIZATION on top of that blending project.

Minnesota naturopathy actually promises not to be that blend, as in a certain stringent unblended category:

science.

Which is it?

Science blended with crap, or science.

There's a difference:

between wine, and wine plus mud.

As regards science, as a stringent categorical label, we're told in "Naturopathic Doctor Directory", by Minnesota NDs at MNANP, that naturopathy is:

"a holistic, yet science-based approach to medicine", that's ND Bush, and that naturopathy is "science-based, clinically verified wholistic medical treatments", and that's our friend ND Glidden, actually, while homeopathy is on that web page twice.

Ah, the Janus-faces:

science, science and junk.

All at once.

For an area that claims to be "whole", that's a very interesting DUALITY.

In sum, naturopathy essentially is quite a muddle, a holistic or wholistic, integrative, combining-blending-conflating muddle.

With a posture that 'this all makes perfect sense.'

Imagine a math professional, wherein:

2 + 2 = 4, and yet also 2 + 2 = 5.

That's a problem; naturopathy essentially makes NO SENSE.

Naturopathy is full of such 'crazy, such batshit crazy'.

Such is what is, for naturopathy:

"strong professional standards" and "comprehensive understanding" and "science-based".

My 'diagnosis of a kind' -- and I mean diagnosis in terms of labeling what I think naturopathy is -- for naturopathy's so-called "understanding", is this:

'ye old time incorrigible and essential knowledge blending and obfuscating',

as opposed to

'modern rigorous analysis, knowledge clarity and transparency'.

Beware, obviously:

naturopathy needs therapy, yet claims to be what's therapeutic.

Because naturopathy has PROBLEMS.

 For instance, I've went to the trunk of the U.S. naturopathy tree, NCNM, that's National College of Natural Medicine.

NCNM tells us, in "A Framework for Action 2012 – 2017" (2016 archived):

"by 2017, NCNM will be an institution of higher education providing graduate medical education in a variety of delivery formats [...] in the natural health sciences field with naturopathic medicine and classical Chinese medicine as its core professional career disciplines [...] providing leadership in research training and research projects in the natural health science fields in North America [...] NCNM will be nationally and internationally known for its commitment to natural health science education [...] NCNM will be the pace-setting national resource supporting the accreditation of natural health sciences programs [...] such a curriculum, alluded to above, teaches students the relevant basic science, followed by the relevant applied science [...] naturopathic physicians John Bastyr, Bill Mitchell and Gordon Smith shifted things a bit three decades ago when they posited that we have to present ourselves not only as the custodians of traditional practice and philosophy, but also as 'rigorous practitioners of a science-based professional knowledge' [...] in the wake of this scientific approach to naturopathic medicine [...] a national leadership role in professional higher education as a private natural medicine and health sciences college [...] rigorous scientific research of naturopathic and Chinese medicine provides clinicians and educators with tools, data and information to improve clinical practice [...] continuously building the scientific evidence for naturopathic and Chinese medicine modalities."

So, I think it's safe to say that the NCNM claim is 'science subset our contents' such as:

'professional subset the natural health sciences subset naturopathic medicine subset Chinese medicine'.

Yet.

Of course 'yet', by way of a google.com search:

>continuing education naturopathic 2016 homeopathy<

you get NCNM's page "NCNM Continuing Education" (2016 archived).

It tells us:

"2016 Homeopathy Symposium.  March 19–20, 2016. This internationally recognized event will present German biologic medicine, complex homeopathy, classical homeopathy and drainage. Scientific evidence will be discussed as to the quantification of energetics of homeopathy. The most recent provings will be discussed as well as the political and federal temperature at this point, for prescribing."

And also offered is, ISYN:

"Chinese Medical Astrology: The Calculation of Life According to the Eight Signs [...] two workshops presented by Manfred Kubny, PhD [...] the School of Classical Chinese Medicine is pleased to host the Western hemisphere’s only presentation of Professor Manfred Kubny's seminal work on [...] this highly sophisticated model of Chinese constitutional and medical astrology [which] has very practical implications for clinical practice."

How practical are:

magic beans, unicorn tears, and flying carpets? 

Homeopathy is completely science-ejected, as well as astrology of whatever kind:

and yet they are termed "natural health sciences".

Again, beware, MOST obviously:

naturopathy needs therapy, yet claims to be what's therapeutic.

Because naturopathy has PROBLEMS.

The Code of Ethics of the American Board of Internal Medicine [ABIM]:

Specifically, the document I'm honing-in on here is ABIM's “Physician Charter”.

This was first published in 2002 in the Annuals of Internal Medicine as “Medical Professionalism in the New Millennium: A Physician Charter”.

At annals.org, we're told the Charter is a:

“project of the ABIM Foundation, ACP–ASIM Foundation [that's the American College of Physicians], and [the] European Federation of Internal Medicine.”

So, that is quite a swath of the medical world in terms of North America and Europe.

The Charter is available online as a PDF at abimfoundation.org at the web page “The Physician Charter” (2016 archived).


To aide me with augmenting aspects of this ABIM Code, I'm going to rely in-part on McGraw-Hill's 2014 published book “Understanding Medical Professionalism”, which I own and have OCR'd for easy searching, and which is centered around this ABIM Charter.

This book's authors include:

Wendy Levinson, Shiphra Ginsberg, Frederic Hafferty, and Catherine Lucey.

I will refer to it as “the book” or “Levinson's book” often.

It was published by McGraw-Hill with ISBNs:

978-0-07-180743-2 and 0-07-180743-8.

Thank you McGraw-Hill for the teacher's review copy.

Regarding the popularity of the Charter, the book states:

“it has become widely accepted around the world, and more than 300 medical organizations worldwide have endorsed it […and ] most physicians agree with the [Charter's] principles and commitments.”

Inevitably, when you look at the history of such kinds of collections of values, the Charter really is a reiteration of modern medical values.

In that sense, I haven't found, let's say, 'resistance' to it.

This is implied, I think, when we were just told that “most physicians agree.”

 That is a preponderance.

Levinson's book tells us also of medicine's epistemic type, in its first-page “notice”:

“medicine is an ever-changing science [...and it speaks of the] medical sciences.”

True that:

we have a kind of filter as the Charter's very basis, and that basis is primarily a science-filter.

I prefer to use this idea of 'filter' in the sense that it is active, as science itself is active as an activity.

Just taking on face value a static science label, as in 'because we study basic medical science, what we LATER do is therefore science or science-supported inherently' obviously isn't logical.

Science is continually an activity that is self-testing and self-correcting.

One day naturopathy may get that.

But, as I've mentioned before in other episodes, if you apply rigorous science to naturopathy overall, what remains after that filtering ALREADY exists as other areas of healthcare AND the 'essentially naturopathic' doesn't survive the process.

This is why naturopathy REDEFINES the footprint of science, lowers the bar, fakes it, changes the rules, moves the goal posts, unlimits the boundaries, pokes holes in the filter itself to therein let their HUGELY unsupported and implausible, often archaic and absurd stuff through.

Levinson's book explains its approach to professionalism as:

“a behavioral and systems approach to professionalism […evaluating] professionalism as demonstrated through a set of behaviors that can be observed […] in four key domains […which are] interaction[s] between clinicians and patients / families [...interactions] among team members […interactions at] the practice settings […and interactions in] the professional organizations and external environment influencing care.”

And regarding that system's approach, we're additionally told:

“the systems view of professionalism reframes a problem […] from a 'hero' image to a team effort [...including] individual physicians, team members, hospital administrators, and professional organizations.”

And as regard behaviors as a focus of professionalism, the book states:

“[people] may think that professionalism is some abstract concept, a theoretical aspirational goal, or a set of principles distant from clinical practice […it is actually] a set of behaviors that can be demonstrated in our everyday work […making professionalism] much more practical and relevant […] simply knowing right from wrong or having an internal compass does not suffice [...professionalism is] defined in concrete behaviors […] a lived approach to the practice of medicine that emanates.”

Now, the Charter proper's Summary states:

“the practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies. These challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patients’ interests. To maintain the fidelity of medicine’s social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system for the welfare of society. This Charter on Medical Professionalism is intended to encourage such dedication and to promote an action agenda for the profession of medicine that is universal in scope and purpose.”

So that was:

challenges, fidelity, the social contract, professionalism, personal patient commitment and social commitment, the welfare of society, reaffirmation, dedication, action, and universality or broadness.

These are good things.

The Charter proper's Preamble states:

“professionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health [...and it speaks of] reaffirming the fundamental and universal principles and values of medical professionalism.”

So that was:

a social contract, fiduciary duty, competence and integrity, expertise, and a universality of professional values.

The next part of the Charter, “Fundamental Principles”, mentions the Charter's three basic categories:

“principle of primacy of patient welfare […] principle of patient autonomy […and] principle of social justice.”

In detail, we're told:

“principle of primacy of patient welfare: the principle is based on a dedication to serving the interest of the patient.  Altruism contributes to the trust that is central to the physician-patient relationship [...] principle of patient autonomy.  Physicians must have respect for patient autonomy.  Physicians must be honest with their patients and empower them to make informed decisions about their treatment […] principle of social justice.  The medical profession must promote justice in the health care system, including the fair distribution of health care resources.  Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.”

So, there's:

serving the patient's interests, altruism, honesty and empowering, patient informed decisions, social justice and fairness, and nondiscrimination.

And the main part of the Charter is “A Set of Professional Responsibilities”, which specifies, in terms of my interests for this episode, such “commitments” as:

“commitment to professional competence [...] commitment to honesty with patients [...] commitment to improving quality of care […] commitment to scientific knowledge […] commitment to professional responsibilities.”

Regarding the commitments, the Levinson book states:

“in order to operationalize the Charter into observable behaviors that can be demonstrated, we grouped the 10 commitments into four core values […] patient-centered care […] integrity and accountability […] fair and ethical stewardship of resources […and] pursuit of excellence.”

The book groups the commitments I'm interested in this way:

the commitments to professional competence and to honesty are within patient-centered care;

the commitments to improving quality of care and to professional responsibilities are within integrity and accountability;

and medicine's ever-so-foundational commitment to SCIENTIFIC knowledge is within pursuit of excellence.

The details for these commitments go as follows, from the Charter:

“commitment to professional competence. Physicians must be committed to lifelong learning and be responsible for maintaining the medical knowledge and clinical and team skills necessary for the provision of quality care. More broadly, the profession as a whole must strive to see that all of its members are competent and must ensure that appropriate mechanisms are available for physicians to accomplish this goal […] commitment to honesty with patients. Physicians must ensure that patients are completely and honestly informed before the patient has consented to treatment and after treatment has occurred. This expectation does not mean that patients should be involved in every minute decision about medical care; rather, they must be empowered to decide on the course of therapy. Physicians should also acknowledge that in health care, medical errors that injure patients do sometimes occur. Whenever patients are injured as a consequence of medical care, patients should be informed promptly because failure to do so seriously compromises patient and societal trust. Reporting and analyzing medical mistakes provide the basis for appropriate prevention and improvement strategies and for appropriate compensation to injured parties […] commitment to improving quality of care. Physicians must be dedicated to continuous improvement in the quality of healthcare. This commitment entails not only maintaining clinical competence but also working collaboratively with other professionals to reduce medical error, increase patient safety, minimize overuse of health care resources, and optimize the outcomes of care. Physicians must actively participate in the development of better measures of quality of care and the application of quality measures to assess routinely the performance of all individuals, institutions, and systems responsible for health care delivery. Physicians, both individually and through their professional associations, must take responsibility for assisting in the creation and implementation of mechanisms designed to encourage continuous improvement in the quality of care […] commitment to scientific knowledge: much of medicine’s contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use. The profession is responsible for the integrity of this knowledge, which is based on scientific evidence and physician experience […] commitment to professional responsibilities: as members of a profession, physicians are expected to work collaboratively to maximize patient care, be respectful of one another, and participate in the processes of self regulation, including remediation and discipline of members who have failed to meet professional standards. The profession should also define and organize the educational and standard-setting process for current and future members. Physicians have both individual and collective obligations to participate in these processes. These obligations include engaging in internal assessment and accepting external scrutiny of all aspects of their professional performance.”

Notice that scientific standards are to be UPHELD, not redefined, not DEGRADED, and the label science is NOT permitted to be used as a deceptive veneer.

There must be scientific integrity:

not deviance, not scientific misconduct, NOT academic misconduct.

And as regards deviance or other unethical behaviors, though it's subtle, the Charter DOES reiterate professionalism's standard 'snitch clause', as I like to call it.

We're told in the Charter:

“[medicine's] commitment to professional responsibilities [...includes the requirement of members to] participate in the processes of self regulation, including [the] remediation and discipline of members who have failed to meet professional standards.”

That is, somewhat subtly stated:

internal 'remediation and discipline' by communicating the issue UPWARDS to structures that would respond.

To not do this, employing a term I'd used in Part One of Part One of this Episode, would be an act of nonfeasance.

Here's something as well, which is under the commitment:

“commitment to improving access to care.”

The Charter tells us:

“medical professionalism demands that the objective of all health care systems be the availability of a uniform and adequate standard of care.”

A standard of care, singular.

That's fascinating, because naturopathy lives in its Own Private Idaho of what is “standard”, and therein offers a DIFFERENT standard.

Science provides for that singular standard, but because naturopathy creates a kind of Bizzaro World science, it leads to a very shoddy naturopathic standard of care.

The standard that's shoved into the mud, wallows, and is called good; as opposed to the standard that aspires on high in the breeze.

Naturopathy lives in a place of 'degraded-science standard of care' posed as BETTER than the 'rigorous-science standard of care'.

Just do this simple search with google.com:

>naturopathic "not just suppress" allopathic<.

My first page first hit is the practice of Alberta, Canada ND Lewis (here) (here).

The page's title is “About Naturopathic Medicine” (2016 archived) and the ND tells us:

“we treat you, not your disease […] naturopathic medicine shines at chronic illness: we can often fix what conventional medicine cannot. Our goal is to find to [sic.] the root cause of the problem and not just suppress symptoms [...using such things as] we have great success utilizing less invasive and less harmful treatments such as nutrition and lifestyle coaching, natural supplementation, botanical medicine, homeopathic remedies, acupuncture, manual body manipulations, IV therapy and hydrotherapy to help a person regain their health […] we spend the majority of the time treating complicated and chronic cases: auto-immune disease, IBS and other gastrointestinal concerns, depression, anxiety, eczema, adjunct cancer treatment, chronic infections, women’s medicine issues, headaches, insomnia, diabetics and many more are where we help the most.”

Notice:

the accusation that regular medicine is inferior and not helping as much, in not getting to the issue itself and just masking, the promise of being AMAZINGLY better, but then you get such nutty claims as “great success” with homeopathy and kind.

This is STANDARD for naturopathy.

She tells us too:

“everybody has miracle stories…but I see them every day.”

Well aren't we full of ourselves.

That's quite the promise of SUPERIORITY, of BETTER-THAN.

Homeopathy TRULY working WOULD BE a miracle.

Actually, though, it's Bizzaro.

And that's naturopathy's STANDARD, based upon naturopathy's pseudoscience basis.

Yet, ND Lewis even provides us with a "Naturopathic Medical Education" (2016 archived) page which tallies naturopathy's "basic and clinical sciences", with MD as in Medical Doctor schools at about the same amount, as if naturopathy is 'just like it'. 

As we're told:

"naturopathic doctors are medically trained in comparable or more hours then offered at top allopathic medical schools."

Allopathy:

that false label naturopathy places upon modern medicine, invented by homeopathy founder Hahnemann.

And there again she reiterates:

"we have great success utilizing less invasive and less harmful treatments such as nutrition and lifestyle coaching, natural supplementation, botanical medicine, homeopathic remedies, acupuncture, manual body manipulations, IV therapy and hydrotherapy."

But, dig beneath all the rhetoric, and you find NOT science as a basis, that UNLIMITED science that ain't.

And the ND tells us:

“as naturopathic doctors we are taught and licensed to perform all the same treatments as any other family physician.”

That's equating.

Yeah, “the same” but without ethical rigor, without epistemic rigor.

This is Bizzaro World Medicine.

Obviously, the fracture from reality into fantasy begins epistemically.

It then fleshes itself out in terms of obligations, practices and care, as the sausage that comes out of the Naturopathy Inc. factory.

Now, I think the trick, so so speak, that naturopathy engages in is to redefine science, as I've said often.

Naturopathy's deviance begins with 'its epistemic re-delineating or LACK of delineating', falsely posed as typical and rigorous.

But, ONLY science gets to define science; peripheral APPLIERS of science don't.

And to emphasize the point I can state this:

NOT EVEN mainstream medicine gets to redefine science.

To do so is INCOMPETENCE at the most fundamental of knowledge levels or bases.

Or it's what I'll call 'a sneaky sectarianism based on a dogma it guards'.

Obviously, if you start with a SNEAKY or OPAQUE redefining of the footprint of science, well, then, what's cranked out of the process of applying that so-called “science” changes, and obligations, care and practice changes in the sense of WORSE.

Such can be detected, if you are into reverse-engineering.

It is possible to figure out post hoc what likely produced a product – and I don't mean here post hoc data dredging – by looking at the quality [cheers NEASC] and composition of the sausage that comes out of the naturopathy factory.

Knowing what the beginning materials were, and the results, tells you a lot about the methods applied within the process; because you can compare this process with other versions of a similar process which are transparently known, which produce sausage of a much better ethical and epistemic quality and type.

For example, because I feel I'm floating away here into abstraction, here's a recent REVELATORY quote that comes to my mind as reported 03-2016.

In a recent Naturocrit post "Alaska's ND Lamb (ND NCNM) Admits Naturopathy's Science Standards Are 'Not Legitimate'" (2015-03-20), I'd written:

“here, a not-that-surprising revelation […] Elizabeth Earl reports at peninsulaclarion.com in 'Alternative Medicine Providers Seek Place in Health Care Reform' (2016-03-19)[vsc 2016 -03-21]

Dawn Lamb [ND NCNM...] who practices in Soldotna, is one of 57 doctors with active naturopath licenses in Alaska and among a handful on the Kenai Peninsula. Natural medicine, as naturopathy is increasingly called, is hinged on the belief that the body can naturally heal itself [that's coded vitalism…] complementary and alternative medicine generates controversy because the medical community does not recognize many types. Lamb includes Eastern medicine practice in her naturopathic clinic, and says it is an important part of her practice. Lamb says it has a scientific base, just not the type Western medicine recognizes as legitimate, she said."

Ah, the “scientific” that isn't legitimate as “scientific”, admitted.

Of course, if you look at NCNM, her alma mater – yes, NCNM from the beginning of this Part 2 with its Chinese medieval medical astrology – you'll find that the school claims lots of things survive scientific scrutiny that PATENTLY don't.

Now, naturopathy self-labels itself a “profession”.


“in Canada, the naturopathic medical profession’s infrastructure includes accredited educational institutions, professional licensing, national standards of practice, participation in many federal health committee initiatives, and a commitment to state-of-the-art scientific research.”

That's:

POSED professionalism, accreditation, standards, and promised science as a filter.

Yet on that page is also homeopathy, and the admission, whether they realize it or not, that naturopathy isn't categorically science.

They state:

“naturopathic medicine is a distinct primary health care system that blends modern scientific knowledge with traditional and natural forms of medicine.”

How can you be distinct if you are blended?

And you can't categorically be science as knowledge and method if so 'blended with other things' not science as knowledge and method.

Again, 'oh the batshit crazy'.

I'll therefore mention that Levinson's book makes a distinction between profession and professionalism.

We're told:

“it is critical to differentiate between profession and professionalism [...the former is] a sociological construct and a way of organizing work […the latter concerns] the underlying ethos driving that work […] as occupationally specific moral imperative [...as] core values.”

Two organizations are mentioned in the book which in title seem like echos of the naturopathic hierarchy, but it is naturopathy that has essentially POORLY copied modern medicine's structure:

the Association of American Medical College's (AAMC) and the Accreditation Council of Graduate Medical Education (ACGME).

Naturopathy's mimicry would be the AANMC and CNME, respectively:


And we're told in the book that AAMC's Medical School Objectives Project includes the following:

“physicians must be altruistic, knowledgeable, skillful, and dutiful.”

The ACGME has a “long-form definition of professionalism” which states:

“residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: compassion, integrity, and respect for others; responsiveness to patient needs that supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society, and the profession; sensitivity and responsiveness to a diverse patient population.”

And we're told:

“MSOP […] targets undergraduate medical education […] ACGME competencies [...target] graduate medical education [...and] the Physician Charter […] targets clinical practice.”

I'll visit naturopathy's poorly mimicking oversight structure later in this episode, when I cover what I'll call naturopathy's 'code that's not a code of unethics.'

It will be quite easy to point out AANMC and CNME's unethicality.

Since so much of the disease at the heart of the naturopathillogical deals with science, I'll now run through a few definitions from the side of 'the legal'.

The Law Dictionary states, in "What is Scientific Knowledge", that:

"[scientific knowledge is] a fact that has been acquired through the scientific method. Testing is rigorous and independent, needs peer review and subsequent publication, needs a measurement of potential or actual error and must gain a degree of acceptance from the scientific community."

At uslegal.com, in "Scientific Knowledge Law and Legal Definition", we're told perhaps a better definition:

"scientific knowledge refers to a knowledge that is based on scientific methods which are supported by adequate validation. There are four primary factors that are used to determine whether evidence amounts to scientific knowledge: whether it has been tested; whether it has been subject to peer review and publication; the known or potential rate of error; and the degree of acceptance within the scientific community. The following is a case law defining scientific knowledge:'scientific knowledge refers to knowledge of a person that must be based on the methods and procedures of science rather than on subjective belief or unsupported speculation. The person must have good grounds for his/her belief. [Robert Billet Promotions, Inc. v. IMI Cornelius, Inc., 1998 U.S. Dist. LEXIS 4235 (E.D. Pa. Apr. 1, 1998)]'."

Now, I just mention such “legal” definitions of science as a REFLECTION of what science is.

But it is not as though science can be LEGALLY decreed in terms of method and scope.

I'd argue that the legal system brings in scientists and DEFERS to their activity and opinions, in sum, as science, as in:

science is what scientists do, what scientists know, preponderantly.

What naturopathy does, in terms of its licensure laws and marketing, is employ the term science as a label and then not disclose that their definition of science is quite bogus, particularly in the sense of rigor.

That is a needless erosion of scientific integrity.

The Charter proper had stated, regarding science:

“much of medicine’s contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use. The profession is responsible for the integrity of this knowledge, which is based on scientific evidence and physician experience.”

So, that's “uphold scientific standards”, use “scientific evidence” to maintain medicine's “integrity of [...] knowledge.”

In the book, we're also told:

“medicine is an applied science [...there's] recognition of the importance of scientific reasoning [...the need] to apply science in the human context [...e.g.] patients with symptoms are worried and want their physicians to use the best of medical science to quickly diagnose and treat a problem or to reassure them that nothing serious is wrong […] physicians who enter practice today can expect to practice for three, four, or even five decades. Maintaining excellence for such an extended period is a tremendous challenge in today's dynamic scientific environment. Scientific advances can dramatically change preventive, diagnostic, therapeutic, and procedural standards of care, requiring physicians to continuously update their practice […] a commitment to strive for excellence is a key component of professionalism. As discussed in Chapter 3, A Brief History of Medicine's Modern-Day Professionalism Movement, expertise in a body of knowledge is the core of a profession, and the social contract between the public and the profession requires that physicians maintain this competency. Fulfilling this obligation begins in medical school with the mastery of foundational social, biomedical,and behavioral science principles. It continues in practice with a commitment to continuously seek out, analyze, and apply the best available science and evidence to make patient care decisions, to continuously update procedural and clinical skills, and to acknowledge personal limitations […] excellent medical care combines sophistication in scientific knowledge with equally sophisticated communication skills to understand the needs of patients, to address their emotions, and to educate patients about their choices in care.”

And the book has a definition of integrity.

We're told:

“integrity can be defined as, 'a virtue consisting of soundness of and adherence to moral principles and character and standing up in their defense when they are threatened or under attack. This involves consistent, habitual honesty and a coherent integration of reasonably stable, justifiable moral values, with consistent judgment and action over time' [...] in healthcare settings we can define integrity as encompassing honesty, keeping one's word, and consistently adhering to principles of professionalism, even when it is not easy to do so [...] integrity and accountability are essential to maintaining the public's trust in the profession. Without them the profession may lose its ability to be self-regulating [...] integrity and accountability are critical to the public trust of physicians and the profession. The privilege of self-regulation is based on our commitment to be accountable to the public. This privilege is one that the profession must not take for granted as, once breached, physicians can lose it—in fact, this is the case in England."

And looking at what is happening with naturopathy in North America, I'd offer this opinion:

such self-regulation is NOT a good thing, because it is the regulation of what is bad.

Regulation doesn't work, of any kind.

It fails, IMHO:

look at naturopathy.

From consumer protection that isn't protecting, accreditation that assures nonsense, State and Federal certification of the certifiably batshit crazy, and the nonfeasance of a medical community that appears to EXPERTLY ignore this naturopathillogical issue.

Now, this leads to 'legal news' I find VERY disturbing to talk about, coincidentally also having already mentioned an ND in Alberta, Canada.

I'll mention it here in the Episode because by the time this Episode is fully published, a verdict will have been rendered in the trial.

By the way, when I asked the College of Naturopathic Doctors of Albert, by email recently:

“I'm wondering what precisely is the CNDA 'standards of practice and professional conduct'? Is it publicly available?”


“the College of Naturopathic Doctors of Alberta (CNDA) is governed by the Health Professions Act. We are currently in the Ministerial review process of developing our Standards of Practice and Code of Ethics. Once these documents are finalized they will be available to the public.”

So, they had NO PROBLEM, with their new self-regulation status, of going full-speed ahead allowing their ND Members to practice apparently without Standards of Practice and a Code of Ethics.

No wonder...

Now, most amazingly, quite recently, Canada's National Post, a very major Toronto-based news outlet, published the Full Comment piece by Alheli Picazo "When Naturopathy Kills" (2016-03-23)[vsc 2016-03-25].

You'll have to forgive me for quoting so heavily from this excellent article.

Can you think of another supposed-profession which can be so criticized 'in-itself'?

Because what she writes about is not BAD naturopathy, or 'naturopathy malpractice'.

The piece is about naturopathy THE WAY IT CLAIMS IT CAN BE USED:

as primary care which means in lieu of modern medicine, which means ABLE to act primarily.

Quite tragically, a toddler had died of meningitis in Alberta, Canada in 2012, and the trial is presently underway.

We're told in "When Naturopathy Kills":

“after weeks of trying 'natural' extracts and homemade remedies like smoothies cut with ginger root and horseradish to cure a suspected case of meningitis, 19-month-old Ezekiel Stephan’s tiny body had so deteriorated that he was too stiff to bend. Unable to be sit in his car seat, Ezekiel’s parents, David and Collet, loaded a mattress into the back of their vehicle to take him to a health practitioner — not a doctor […] a naturopath, whose clinic they’d contacted days earlier in search of something to 'boost Ezekiel’s immune system' […this was] Dr. Tannis, the naturopath who prescribed echinacea for a child suffering a life-threatening illness [who] graduated from the Canadian College of Naturopathic Medicine in 2003 […] the profound suffering and preventable death of Ezekiel has rightly provoked heated discussion about the validity of so-called alternative medicine, prompting finger-pointing toward all who enabled and abetted the long deterioration and ultimate death of a toddler whose ailment was both vaccine-preventable and entirely treatable.”

And that is quite tragic.

Naturopathic.org, the home page of the American Association of Naturopathic Physicians,
has the ND Clinton authored page “Preparing Yourself for the Flu Season Naturally” (2016 archived) which offers similar suggestions to “boost immune function.”

So, the parents' strategy is QUITE naturopathic.

Now, it may not be the case that “when naturopathy kills” concerns the behavior of the naturopath, primarily.

After all, it is the parents who are accused in the toddler's death.

It is the parent's naturopathy worldview that is the issue of "when naturopathy kills."

We're told:

“now on trial for Ezekiel’s death, the Stephans pleaded not guilty to the charge of failing to provide the necessities of life, maintaining they’d pursued a legitimate, alternative course of treatment.”

That too sounds very naturopathic:

naturopathy's claim that what it does is “science-based” as in legitimate.

And the author does sympathize with the ignorant, stating:

“for those immersed in the pseudoscientific realm of 'alternative health care,' this, indeed, seems to be a perfectly reasonable defense [...but] one thing is clear: Ezekiel is a casualty of pseudoscience; his death facilitated by the allure of alternative medicine.”

Indeed pseudoscience.

Right on the mark.

Ms. Picazo continues:

“the same government that is now prosecuting the Stephans has also granted the College of Naturopathic Doctors of Alberta (CNDA) the power to self-govern their industry — in essence, the state is now prosecuting parents for pursuing cures from a modern-day snake-oil industry that it licenses and legitimizes […] to this day, many procedures on its [naturopathy's] standard list of practices and cures have not passed scientific muster.”

HOLY COW.

Now, the CNDA claims, presently, in the document "Frequently Asked Questions About Naturopathic Doctors in Alberta" (2016 archived):

"naturopathic programs include basic and clinical medical sciences [and here's where I note on the board exam homeopathy is considered a clinical science though it is the utmost of bogus therapeutics...] NDs study the same basic medical and clinical sciences as other healthcare professionals [this can't be true if their definition of science is different...] these sciences lay the foundation [...] many naturopathic treatments have been researched and been proven safe and effective for numerous conditions [why is it only many?  Shouldn't naturopathy be using only that which is science supported if they are practicing so-called clinical medical sciences?...] scientific examination of naturopathic methods is important, helping to bring clarity and refinement to the traditional and historical use of various therapies [when in fact scientific examination discards those...] naturopathic doctors are trained in homeopathy as part of the many therapeutic modalities that we can use [...] traditional treatment methods such as botanical medicine, acupuncture, homeopathy, and nutrition.”

Science as a foundation does not lead to 'homeopathy and kind'.

So, with this press, perhaps 'holy cow no more':

as in 'naturopathy EXPOSED as just another pseudomedical, archaic idiocy.'

As an organized racket in the marketplace.

Ms. Picazo tells us:

“when it granted the CNDA its powers back in 2012, Health Minister Fred Horne said that he and his fellow elected representatives 'believe the practices that will be engaged in by (naturopathic) professionals are safe and effective and meet the highest possible standard' […yet] naturopathy relies on dubious diagnostics — hair analysis and IgG food intolerance screening, for instance — to identify non-existent deficiencies or fabricated ailments. The prescribed interventions, conveniently, are on hand and sold directly by practitioners. Treatments range from the proven-ineffective and largely innocuous, such as vitamin C infusions and herbal supplements, to the far more dangerous and potentially fatal ozone and chelation therapies […and] naturopaths endanger public health by agitating against vaccination, selling homeopathic nosodes [which are prophylactic homeopathic vaccine alternatives], which, to be clear, are entirely inert.”

So such labels as “safe and effective […and] highest possible standards” weren't even true back then in 2012.

And Ms. Picazo tells us:

“naturopathy [...] is not a form of medicine, but a system of belief; its approach to treating illness reliant on the theory of vitalism. That is, disease is viewed as being caused by an imbalance of vital forces and, thus, the treatment rests in the restoration of those forces.”

OMG, that's what I write about and write about and write about.

We're also told, regarding naturopathy's homeopathy, that homeopathy:

“remains one of the central tenets of naturopathy […] as Timothy Caulfield, professor in the Faculty of Law and the School of Public Health at the University of Alberta wrote in 2013: 'there is no evidence that homeopathy works, and given the absurd nature of the proposed mechanism of action, no scientifically plausible reason that it should work.'”

I write a lot about that too, to show just how LOW naturopathy's laxities are.

Overall, we're warned in this National Post article:

“naturopathy preys on the critically and terminally ill by peddling false hope and sham treatments with exorbitant financial and emotional costs; it fuels scientific illiteracy by accommodating those who misunderstand or distrust legitimate medicine, prescribing futile detox and cleanse regimens […] when governments capitulate to the demands of a pseudoscientific lobby, as Alberta did in 2012, such nonsense is granted authority.”

Hear, hear.

We're also told:

“if naturopaths, homeopaths, osteopaths or any of the numerous 'natural' or 'holistic' practitioners want to be regarded as heath-care professionals and afforded the same respect, opportunities and privileges earned by those working in the evidence-based medical system, they must agree to be held to the same standards in terms of education, certification and efficacy of their prescribed treatment.  Until the alternative heath industry is required to demonstrate the validity of its existence, the corpses that refute it will continue to mount. And all who overtly or indirectly enable the spread of pseudoscience share the blame for the casualties.”

So, I award this article 'the perfect rebuke of the essentially naturopathic' award.

And just to touch back towards the ethical theme of this Episode, Ms. Picazo also coincidentally writes:

“though undoubtedly lucrative, embracing and incorporating magical thinking into the realm of evidence-based medicine is both ethically questionable and professionally irresponsible.”

This has been the first half of Part Two of the Naturocrit Podcast Episode 012.

Thank you for boldly listening.




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