this is the script and annotations for the multi-part Naturocrit Podcast Episode 015, aka s02e05, titled “The JACM 2019 Special Issue on Naturopathy”.
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in
this first third of Episode 015 Part 2, I will take a break from the SIN
proper and share my 2021 Master's degree capstone product, which asks
and answers this question:
"Is care founded upon epistemically
unwarranted medical claims and methods an appropriate publicly-funded
remedy for America's underserved and vulnerable populations' rampant
healthcare inaccessibility and inequality issues? The case of Bastyr
University’s Center for Natural Health and BU’s satellite community
clinics":
Medicaid exists to provide care for the vulnerable CITATIONS: (Medicaid, 2021b; Medicaid 2021a).
Washington State particularly offers wide coverage for qualified residents through its Medicaid network CITATION: (Community Health Plan of Washington, 2021).
Naturopaths can bill Medicaid in Washington State CITATIONS: (Health Professions Directory at healthprofs.com, 2021; Washington Association of Naturopathic Physicians, 2013) as well as in Oregon and Vermont CITATION: (La Corte, 2014).
Generally speaking, though states are given a large amount of discretion, they are overseen federally CITATION: (Medicaid, 2015).
The list of benefits is quite robust, yet, there are some services and therapies naturopathic patients cannot get coverage for from Medicaid in terms of odd tests and supplements according to Bastyr and Boucher ND graduates practicing in Washington State CITATIONS: (Schule et al., 2021; Janel and Lang, 2021).
In the interest of this project and its local site, it suffices to acknowledge that Washington Apple Health, which is Washington State’s Medicaid program CITATION: (Washington State Health Care Authority, 2021), does permit naturopaths to be “covered” primary care providers through their network CITATIONS: (Washington Apple Health, n.d.; Molina Health Care, 2020) and as indicated below, the primary local site accepts Medicaid.
Table 6.
BU, BCNH, and BUC Sites that Mention Acceptance of Medicaid as Payment
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|
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Bastyr.edu (primary site in Seattle)
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“Bastyr Creates New Cancer Patient Assistance Program” CITATION: (BU, 2011b); |
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Bastyrcenter.org (primary site in Seattle)
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“Insurance and Billing” CITATION: (BCNH, 2021c); “New Long-Term Birth Control Option Now Available” CITATION: (BCNH, 2016);
|
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Bastyrclinic.org (primary site in San Diego)
|
No hits. |
01.01.19
SIDEBAR
One of the reasons this capstone has the title that it has is to center the main local site at Bastyr University’s Washington State locations since they explicitly state they are engaged with Medicaid.
Concurrently, bastyrclinic.org in San Diego, California is very helpful in terms of providing information on what naturopaths do, though they don’t state such engagement, since they are essentially the same institution.
CLOSE SIDEBAR
Granularly speaking, it appears that Medicaid is only in use in the Washington State BU sites.
One
of the limitations of this project is a lack of access to the progress
notes and the entailing CPT billing items that were generated and
submitted to Medicaid by BU sites.
What did Medicaid expressly pay for and was it coded correctly in the first place in terms of an explicit and justifying medical necessity?
Below is a look at the case or local site example as seen through the eyes of both Medicaid’s ‘fraud, abuse, and waste’ prohibitions CITATIONS: (CMS, n.d.; National Conference of State Legislatures, 2021) and a summation for any overall issues of quality.
For this section, within Table 7, BU host activities or characteristics are assessed in light of such Medicaid restrictions but within a nonmonetary, normative, quality-conscious sense.
Commerce Considerations.
It is quite useful to score the incongruence between BU’s labels/claims and BU’s actual contents through a comparative ‘usual, customary, and reasonable’ preponderance CITATION: (healthcare.gov, 2021) except instead of basic monetary value assign a binary acceptability value [of Y/N] to the therapeutic offerings or behavior at BU.
This is in comparison with what one should expect from a similar regionally accredited university using similar categorical labels in terms of accountability, improvement, and academic quality expectations CITATION: (Council for Higher Education Accreditation, 2021).
Scorings of the Local Site host.
The following will be a rating of the contents discussed above as Table 7 in terms of Medicaid restrictions, commerce expectations, and quality issues.
A qualifying term has been intentionally listed before the BU activity or characteristic.
Therein, false, coded, false, and undeclared begin each row.
Y is yes, and N is no, of course, for items in each column.
Table 7.
|
Medicaid Restrictions |
Commerce Expectations |
Issues of Quality |
||||
|
BCNH and BUC activity or characteristic
|
Fraud |
Abuse |
Waste |
Usual |
Customary |
Reasonable |
Explicit.
|
|
false science categorizations
|
Y |
|
|
N |
N |
N |
|
|
coded therapeutic goals
|
|
Y |
|
N |
N |
N |
|
|
false science expertise
|
Y |
|
|
N |
N |
N |
|
|
undeclared sectarian medicine
|
|
Y |
|
N |
N |
N |
|
01.05.21
SIDEBAR:
In other words, what this table represents is fraud and abuse, and unusual, uncustomary, and unreasonable commerce.
And a broad/generalized explicit issue of quality in both the sense of Medicaid restrictions and the sense of commerce expectations.
CLOSE SIDEBAR.
Overall Impression from the Literature:
As has been mentioned, two knowledge models are at work in the naturopathic literature, at the clinical local setting and within the academic institution setting.
With natural health science, Model 2 as the epistemically unwarranted as being wrapped in a disguise of Model 1 the epistemically warranted thus resulting in what can be termed science fakery CITATION: (Hopf et al., 2019, p.2).
There is the generally accepted mainstream health professions’ rigorous Model 1 and the pernicious Model 2 of natural health science that is basically impersonating Model 1 by means of academic fabulism CITATIONS: (Fleming and Gutknecht, 2010; Dunne et al., 2005; Jagtenberg et al., 2006; Connecticut State Department of Public Health [CTSDPH], 2017).
In terms of the continuous oversight of naturopathy, five areas are apparent: accreditation, licensure laws, national examination, past criticism, and general aptitudes about falsehoods.
The following will discuss those major areas as failed efforts that either continuously disingenuously assure or intermittently honestly criticize but are swamped by proponentry.
Prior Efforts to Solve the Identified Problem:
Accreditation.
The local site, Bastyr University in both Washington State and California, is accredited by the regional accreditor the Northwest Commission on Colleges and Universities [NWCCU], the Council on Naturopathic Medical Education [CNME], the Accreditation Council for Education in Nutrition and Dietetics [ACEND], the Accreditation Commission for Acupuncture and Oriental Medicine [ACAOM], the Midwifery Education Accreditation Council [MEAC], the Washington Student Achievement Council [WSAC], the Bureau for Private Postsecondary Education [BPPE], and the National Council for State Authorization Reciprocity Agreements [NC-SARA] CITATION: (BU, 2021b).
We are told all this amounts to very rigorous educational standards.
On this accreditation page, there is a mandatory link to the BU viewbook for their naturopathy program that assures the reader the coursework is rigorous and science-based.
Simultaneously, that great bellwether of laxity and absurdity, homeopathy, appears in the brochure at least ten times.
The CNME is interesting too, in that the consortia of schools granting naturopathy degrees in both the U.S. and Canada include National University of Health Sciences which is obviously a categorical science label placed upon such things as naturopathy’s homeopathy and kind CITATION: (Council on Naturopathic Medical Education [CNME], 2020a).
CNME’s new school in Puerto Rico is within a supposed division of health sciences as well.
CNME’s explanatory page labels naturopathy’s contents as blended and it codes vitalism CITATION: (CNME, 2020d).
The CNME Handbook for Accreditation codes vitalism, includes homeopathy, and tells us the national exam is comprised of two parts, both with the category science in their titles CITATION: (CNME, 2020b).
Yet, CNME tells us their mission is quality assurance, that the education is high-quality, that the therapies have efficacy, and that their accreditation approval allows for licensure examination CITATION: (CNME, 2020c).
Licensure Laws.
The licensure laws for naturopathy, and there are currently only 22 states that license CITATION: (American Association of Naturopathic Physicians, 2021), require the national examination known as NPLEX.
Written into the laws is the categorical label “science” upon such parts as NPLEX 2 which contains homeopathy.
That is licensed falsehood, and it creates a very weird permission to engage in falsehood with state approval.
This occurs even in my state of Connecticut CITATION: (CTSDPH, 2021) through a public health government branch that itself labeled naturopathy as not science in its special report to the state assembly CITATION: (CTSDPH, 2017).
National Examination.
The State of Connecticut’s naturopathy page links to NABNE, the North American Board of Naturopathic Examiners.
NABNE’s NPLEX examination in clinical sciences, as mentioned, includes homeopathy CITATION: (North American Board of Naturopathic Examiners [NABNE], 2021).
NPLEX assures the public that their exam is excellent, reliable, and a valid assessment CITATION: (NABNE, 2019).
This is while homeopathy, scientifically speaking, is quite bunk CITATIONS: (National Health Service, 2018; Australian Government National Health and Medical Research Council, n.d.).
Here, too, it should be noted that the removal of homeopathy and kind from naturopathy is not a solution to Model 2 problems.
The therapy is a useful bellwether, a symptom so to speak, as has been mentioned, regarding epistemic laxity and permitted absurdity, but there are a priori predilections that underlie naturopathy’s treatment choices and false postures far upstream from their selected interventions that explain these activities.
Gaps in Scholarship and/or Practice that Make the Problem Persist.
Past Criticisms That Evaporate.
One of the greatest of scholarship gaps is the failure of peer-review to hold natural health science papers to stringent standards through and through.
The recently published paper by Carè et al. is quite revealing of the phenomena in that many critical articles are ignored though the paper purports to be comprehensive in terms of its survey of stakeholders CITATION: (Carè et al., 2021).
This flows from natural health science’s preference for narrow, manipulative, sectarian behavior.
The source of that Carè et al. paper is a naturopathy paper publishing shop in Australia at the University of Technology Sydney CITATION: (University of Technology Sydney [UTS], 2021a).
There’s simply no way enough critical articles could be written because their apparent strategy is to swamp the databases with promotional, manipulative articles.
That UTS page tells us naturopathy is a modern science- and evidence-based practice.
Wardle, a co-author, is a co-editor of a textbook that places the science-ejected at the heart of naturopathy in its first chapter CITATION: (Sarris and Wardle, 2019).
He is based out of UTS and his CV there tells us he has a “Bachelors of Health Science (Naturopathy)” CITATION: (UTS, 2021b).
General Aptitudes About Falsehoods.
A question arises as to whether undergraduate education prepares potential naturopathy applicants in a manner that provides for less gullibility and therefore less likelihood of being grifted.
One may wonder, too, as to whether higher-degreed health and medical personnel -- faculty, administration, governing boards -- lack such aptitude.
There are so many ‘.edu’ sites currently promoting naturopathy’s disorientation.
For instance, the University of Minnesota has a long-standing naturopathy promotional page that specifically labels naturopathy science-based while listing its requisite homeopathy and kind CITATIONS: (University of Minnesota, 2016; Internet Archive Wayback Machine, 2021).
This is similar to the two long-standing peer-reviewed articles previously mentioned that promote naturopathy in mainstream medical journals and whose false science categorical claims are uncontested to this day CITATIONS: (Fleming and Gutknecht, 2010; Dunne et al., 2005).
Implications:When considering the implications of this literature review, it is quite necessary to mention two global ethical imperatives in terms of knowledge quality and behavior, that of the American Association for the Advancement of Science [AAAS; I am a casual dues-paying member] and that of medicine in general.
AAAS speaks of abiding by preponderant stringencies in terms of scientific integrity and professional ethics CITATION: (AAAS, 2021).
There is also the more international American Board of Internal Medicine Foundation’s [ABIMF] “Medical Professionalism in the New Millennium: A Physician Charter”.
Under ABIMF’s section commitment to scientific knowledge, we are reminded that one duty of physicians is to uphold scientific standards and defend the integrity of scientific knowledge CITATION: (American Board of Internal Medicine Foundation, 2021).
Additionally, as a requirement for Medicaid participation, the reporting of fraud and abuse is mandatory CITATION: (CMS, 2021).
These implications are also in light of preponderant education professional ethical precepts
CITATIONS:
(United Nations Educational, Scientific, and Cultural Organization
International Institute for Educational Planning, 2020).
It is in the vein of those four obligation sets that the following assessments and suggestions are made.
[Continues in next post].
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