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:
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.'
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.
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.
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:
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.
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'.
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.
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?
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).
The PDF document is also titled
“Medical Professionalism in the New Millennium: A 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<.
>naturopathic "not just suppress" allopathic<.
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.
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.
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”.
A practice that includes ND Lewis even
states, in “What
is Naturopathic Medicine (as defined by the Canadian Association of
Naturopathic Doctors (CAND))?” (2016
archived):
“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).
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:
the Association
of Accredited Naturopathic Medical Colleges and the Council
on Naturopathic Medical Education.
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.
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?”
I was told by a Kristen Tanaka, whom NABNE lists as CNDA's “secretary / assistant registrar” (2016 archived):
“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].
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.
This has been the first half of Part Two of the Naturocrit Podcast Episode 012.
Thank you for boldly listening.
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