in this multi-part Naturocrit Podcast Episode 015, aka s02e05, titled “The JACM 2019 Special Issue on Naturopathy”, aka SIN, I’ll be primarily looking at a collection -- as published in the Journal of Alternative and Complementary Medicine and sponsored by the University of Technology Sydney, Australia -- of around 15 articles specifically about naturopathy from contributors largely located in Australia and North America.
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In this second part of Episode 015 Part 2, continuing my break from the SIN proper, I will delve into a paper I'd written about IM in CM from 2019.
Additionally, I'll first include a statement by the World Medical Association on pseudoscience and pseudotherapies that didn't exist when the capstone was written but surely would have been included had it. I then compare that WMA declaration, in part, with aspects of North American naturopathy.
001. Episode 015b2 Script and Annotations:
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".
The Naturocrit Podcast Episode 015b2 Otherwise Known as s02e05b2.
In this multi-part Naturocrit Podcast Episode 015, aka s02e05, titled “The JACM 2019 Special Issue on Naturopathy”, aka SIN, I’ll be primarily looking at a collection -- as published in the Journal of Alternative and Complementary Medicine and sponsored by the University of Technology Sydney, Australia -- of around 15 articles specifically about naturopathy from contributors largely located in Australia and North America.
In this second part of Episode 015 Part 2 – and I apologize for the layers, so it may be easier to refer to this as s02e05b2 – as planned, I will delve into a 2019 paper I'd written about integrative medicine within conventional medicine during my M.S. in Health Sciences.
Additionally, I'll first include a declaration by the World Medical Association regarding pseudoscience and pseudotherapies that I wasn’t aware of when the capstone from part 1 of Episode 015 Part 2 was written in 2021, but surely would have been included had it shown up on my radar.
In that synopsis, I’ll also compare the World Medical Association to the World Naturopathic Federation, in part.
The World Medical Association’s “Declaration on Pseudoscience and Pseudotherapies in the Field of Health” as Adopted October 2020.
The web page version of this document at wma.net has the tags:
“alternative therapies, false science, false therapies, pseudoscience, pseudotherapies, unproven therapies.”
The PDF version has OCR errors, incidentally, particularly regarding the letter ‘f’, and the grammar could use a light editorial hand.
But I do understand it is a multinational document with likely diverse international contributors and with perhaps some language migration and translation during its creation process.
I mention those two issues not to ‘bust chops’, but, in case someone seeks to use the document through such tools as ATLAS.ti for something like a literature search or review.
Centrally, about a third of the way into the document, we’re reminded of the interlocking commitments of modern medicine.
“a physician's duty is to provide quality medical care to all patients based on best available scientific evidence, as referred in the WMA Declaration of Geneva and the International Code of Medical Ethics commending the highest ethical norms and quality care for the safety of the patient. The interest of the patient must be placed before any other interest, including the physician's own. The WMA reaffirms its Lisbon Declaration on Patient Rights and recalls that Patient Safety requires addressing all opportunities for the patient to receive appropriate, evidence-based care.”
Surely.
The document begins with two definitions, for pseudoscience and pseudotherapies aka, respectively, false science and false therapies.
Pseudoscience is defined as “statements, assumptions, methods, beliefs or practices that, without following a valid and recognized scientific method, are falsely presented as scientific or evidence-based.”
Pseudotherapies are defined as “those practices intended for curing diseases, alleviating symptoms or improving health with procedures, techniques, products or substances based on criteria without the support of available up-to-date scientific evidence; and which may have significant potential risks and harms.”
The document’s Preamble states:
“medical practice must be based on the best available up-to-date scientifically proven evidence. The differences between conventional medicine and other practices that are not supported by scientific evidence make up the complex universe of pseudosciences and pseudotherapies.”
And that is quite a preponderance.
With that language, “conventional medicine”, you can see why this document is helpful towards introducing my “integrative medicine in conventional medicine” paper.
The next paragraph states:
“pseudosciences and pseudotherapies represent a complex system of theories, assumptions, assertions and methods erroneously regarded as scientific, they may cause some patients to perceive a cause-and-effect relationship between pseudotherapies and the perception of improvement, hence they may be very dangerous and are unethical.”
Hear, hear.
Further down we’re told:
“pseudoscience and pseudotherapies may have significant potential risks and harms for various reasons […including] a risk that patients abandon […] proved-to-be effective medical treatments or prevention measures in favor of practices that have not demonstrated therapeutic value […a] likelihood of dangerous delays and loss of opportunity in the application of medicines, procedures and techniques recognized and endorsed by the scientific medical community as evidence-based effective interventions […] they may cause patients to suffer financial damages, psychological-physical traumas, and go against the dignity of people, threatening their moral integrity […] unproven therapies may contribute to the rising costs of healthcare procedures.”
Now, the document has actionable recommendations on the national, member & professional, and individual physician levels.
In terms of the national area, regulation, non-reimbursement, and public campaigns are advised.
Probably my favorite statement, within the member-profession area, is:
“pseudotherapies and pseudosciences should not be regarded as medical specialties recognized by the scientific community and legally endorsed as a specialist or sub-specialist pseudoscience.”
For the physician area, the WMA declaration states:
“physicians must continue to practice medicine as a service based on the application of critical scientific current knowledge, specialist skills and ethical behavior […] the patient must be kept duly informed about the available therapy options, their effectiveness and risks, and be able to participate in the best therapeutic decision-making. Good communication, mutual trust and person-centered healthcare are cornerstones of the physician-patient relationship. Patients and physicians should and must be able to discuss the risks of pseudoscience and pseudotherapies. Health education is fundamental […] physicians should be educated to identify pseudoscience/pseudotherapies, logical fallacies, and cognitive biases and counsel their patients accordingly. They should be aware that some patient groups, such as patients with cancer, psychiatric illnesses or serious chronic diseases, as well as children, are particularly vulnerable to the risks associated with using pseudotherapies.”
As a scientific skeptic, it’s always great to hear ‘logical fallacies’ mentioned, amongst other things analytical and critical.
In light of that excerpted document language, I’ll briefly visit the World Naturopathic Federation, and specifically its member institution NUNM, for a sense of comparison.
Comparatively, if the WMA is the Justice League, well then the WNF is the Legion of Doom.
If you like your comic book heroes’ and villains’ clubs.
A Short Comparison Between WMA and WNF in Light of the 2020 Declaration.
Some things that come to mind for this comparison, boiled down from my WMA excerpts, are:
the primacy of the overarching activity of science as an epistemic filter;
the primacy of ethicality which I think derives from that filtering process;
the primacy of evidence, sort of a reiteration that also sounds legally useful;
the fact that fake science and fake therapy are discernible;
the fact that the medical and health footprint encompasses the theoretical, the assumed, the asserted, and the performed -- I’ll term this later ‘from bow to stern’;
no fake pseudoscience health or medical specialties that are legally protected;
the need for patient informed consent and for their collaboration;
the need for education of physicians regarding the pseudo-, logical fallacies, and biases;
and concern particularly for the most vulnerable.
So, for the sake of brevity, I decided to make a table but one that is easily vocalized.
The first column heading is WMA Stipulation, the second column heading is WNF Reversal, and the third column is termed ‘U.S. Transgression Example’.
Since I’m limiting this to the United States, I’ll point out that the American Medical Association is a WMA member.
I’ll also point out that NUNM, the naturopathy school I’ll emphasize in the table, is a WNF member.
|
WMA Stipulation
|
WNF Reversal |
U.S. Transgression Example |
|
Science and Ethicality |
Pseudoscience and the Unethical |
A great example is, well, the trunk of the North American naturopathy tree, NUNM. In their explanation of naturopathy, they state: “Practice of naturopathic medicine emerges from six principles of healing. These principles are based on the objective observation of the nature of health and disease and are examined continually in light of scientific analysis. These principles stand as the distinguishing marks of the profession.” And that's from nunm.edu. And within that list of six is the science-ejected such as vitalism, and the science-exterior such as supernaturalism. That sets up an ‘anything goes’ structure, in terms of what is and isn’t science and what is and what isn’t good to do – at an institutional level as a model of behavior for their individual ND graduates. Is it no wonder that from this flawed theoretical basis, the activities of naturopathy, as described by NUNM, include such science-ejected ideas as homeopathy. And that also is from nunm.edu.
|
|
Evidence |
Faith/Belief |
Within the naturopathic principles that I just drew from above, we are told that the science-ejected concept known as vitalism is objectively verified, continuously scientific vetted, and “in fact”. There is no such status for vitalism. Therein, to be blunt, what charitably falls into what could be called an article of faith is being falsely portrayed as in-fact and in-evidence in a scientific sense. I’ve said this many times in the past, in terms of the vernacular: this is a mindfuck. And, as I termed such in my capstone, a part of naturopathy’s ‘disoriented esotericism’.
|
|
Distinction |
Blending - Indistinction |
Speaking of such, disoriented esotericism and mindfuck, how about this NUNM language: naturopathy is termed distinct -- from nunm.edu -- while its hallmark is blending -- also from nunm.edu. No wonder one easily finds NUNM ND graduates whose public facing practice pages state "naturopathy is a distinct type of primary care medicine that blends”. That is stated by NDs Alston and Hart at swfamilyphysicians.com in Oregon, as acquired through a basically random google.com search using that language. You also find, commonly, instead of blends the word combines. Sadly, too, that exact quote is from the mainstream journal Primary Care from the year 2010, co-written by NUNM ND graduate Gutknecht. You can find that up at nlm.nih.gov. Within the article, naturopathy is also located, through a list of accredited schools, within “National University of Health Sciences” with therapeutic aims to alter a “life force” and employing such things as “homeopathy”. The root ‘homeop’ is actually in the article at last 34 times. That article is supposedly peer-reviewed, and it is unredacted to this day. The other way to state this irrational Blending – Indistinction is: Naturopathy is a science that isn’t scientific. It is a distinction that isn’t distinguishing. What’s unscientific is science, what’s blended is distinct. Madness.
|
|
From Bow to Stern
|
Special Rules |
Now, the WMA states that an area’s ideas right on through to its activities are up for scientific scrutiny when it claims health and medicine. No sacred cows, so to speak. Naturopathy claims special rules, or sacred cows, that protect its nonsense from such standard scrutiny. The two shields I’ll talk about are the use of the terms philosophy and holistic. Philosophy isn’t philosophy if it's wrong, I’ve so stated in this Episode. Therein, it is not a philosophy to hold out that the science-ejected is science, that an article of faith is an objective fact. It is simply wrong. It is simply another ‘reversal of values’ that naturopathy engages in. Actual philosophy does, as WMA’s document does, distinguish what’s fake from what’s authentic, such as pseudoscience from science. And it distinguishes an article of faith from an objective science-supported fact. Such distinctions functionally happen all the time in the legal context as well. Holistic is an almost meaningless word because the follow-up question when it is used is, necessarily, ‘what are you including in your whole?’ But, it seems that society has been trained to shut off all thought once the magic word is spoken. The simple retort is to ask for clarification as to what is included in the holistic that the user is invoking in their ‘all’ or ‘holism’. That granularity then reveals what’s being rhetorically hidden. A sister school to NUNM, Sonoran University of Health Sciences – formerly SCNM – states in their announcement of their name change in May of 2022 that it is: “Southwest College of Naturopathic Medicine & Health Sciences […] the leading institution dedicated to holistic and natural approaches to medicine and health sciences […and they are] proud to announce it will transition to Sonoran University of Health Sciences in September 2022. The new direction is indicative of a larger shift towards highlighting the school’s multiple unique degree offerings related to the healing power of nature […Sonoran is] the preeminent health sciences institution grounded in the healing power of nature.” And that's from sonoran.edu. Or, as their catalog of that year states, there’s an overall therapeutic aim, an activity, to “harmonize life force […aka] stimulate the healing power of nature”. And that's from my.sonoran.edu. So, the activity of holistic subset science subset coded vitalism, which is science-ejected.
|
|
Not to legitimize as specialty |
As specialty |
Broadly, according to the AANMC school consortia of ND schools of which NUNM is a member, “naturopathic medical education is the most efficient and direct way to train as a primary care doctor who specializes in natural medicine.” And that's from aanmc.org. We’re also told there, true to form, that they are distinct in that they combine. It gets better. How about a ‘naturopathic board-certified oncologist’, FABNO via OncANP from oncanp.org. It is the very real situation of naturopathy in North American actually posing as a specialty area that is scientific, and possessing legal status to do what they do, pseudoscience and pseudotherapy, directly in contradiction to the WMA's position.
|
|
Informed Consent |
Broken Consent |
I’ve become particularly interested in naturopathy’s online consent forms that do not encapsulate naturopathy’s nonsensical and fraudulently labeled positions in clear and simple terms. There is, for instance, the “Patient Manual” of 1990 NUNM ND graduate Dick [here]. It includes such pseudodiagnostics as acoustic cardiograph, Bolen testing – a form of dry blood analysis – and iridology, and such pseudotherapeutics as homeopathy, which she terms explicitly “scientific.” Vitalism, globally in the document, is of course coded. In the section “Informed Consent for Treatment”, the patient is actually told “we will always strive to provide full disclosure of all information relevant to your health care” while on that very page the vitalism of homeopathy, and naturopathy overall, is disguised. And nowhere is an alert regarding inherent bogosity mentioned. Instead, were asked in the section Research Release “The naturopathic community is continually interested in furthering the goal of naturopathic medicine through scientific investigations and research. Would you consent to our use of your medical records by qualified investigators under protocols approved by an appropriate Institutional Review Board and/or utilized for teaching purposes? Your anonymity will be guaranteed.” How legitimate sounding. I wouldn’t trust them with knowledge of my middle initial, never mind several pages of intimate information regarding my medical and health status and history.
|
|
Physician education |
Physician miseducation |
Just as a general note, the conventional medical community seeks to foster physician acumen while the naturopathy community seeks to indoctrinate.
|
|
Protection of the vulnerable |
Exploitation |
Obviously, naturopaths’ posing as physicians is the allure that draws people into naturopathic nonsense. The exploited are patients largely, but there are also those who trust the false language and become students. And lots of other stakeholders, like the healthcare system itself. |
By the way, it has been announced that NUNM is basically failing as a viable institution and is merging with nearby Bastyr University.
In a competitive sense, I think that indicates a positive trend towards marginalization of what is unfit.
And, of course true to pseudoscientific form, BU states naturopathy is “science-based natural health and medicine.”
And that's from bastyr.edu.
This is similar to the recent failure of Boucher Institute of Naturopathic Medicine in Canada, that has been taken over by Canadian College of Naturopathic Medicine.
And that's from naturopathic.org.
We might as well get Interpol involved in this [that is, bring up Canada and not just the U.S.].
And, of course since organized Canadian naturopathy is organizationally complaint with all the contents and processes of U.S. organized naturopathy so they can basically sit for the same NPLEX licensure exams and have a unified North American status, CCNM similarly can be found to use the overarching label “science” upon what is science-ejected and termed holistic.
CCNM's academic calendar for 2023-2024 states:
“the clinical science examinations are taken following graduation (after the fourth year of school). They include […] homeopathy […] utilizing naturopathic principles, naturopathic doctors employ evidence-informed approaches to facilitate patient wellness and promote the body’s ability to restore and maintain optimal health.”
But, of course, like homeopathy and the central naturopathic principle, vitalism -- here coded as “body’s ability to restore and maintain optimal health” -- there is no evidence to support them as they are science-ejected.
To gird that ‘coded vitalism’ observation, because their naturalistic language is so opaque that it is often hard to believe that it is an act of coding, the document states, as course descriptions:
“year 1 […] ANM100: Introduction to Naturopathic Medicine […] the course engages students in an exploration of the basic underlying principles of naturopathic medicine which are understood through philosophical discussion of concepts such as holism, vitalism, and health […] NPH101: Naturopathic History, Philosophy and Principles. This course engages students in an exploration of the basic underlying principles of naturopathic medicine. These principles are understood through philosophical discussion of concepts such as holism, vitalism, and health.”
The root ‘homeop’ is in the document at least 48 times.
Additionally, for the holistic label, see ccnm.edu's teaching clinic’s homepage at rsnc.ca, which states:
“Robert Schad Naturopathic Clinic. An affordable, natural, holistic and team-based approach to health care.”
There, one also gets a little peak at naturopathy’s essential vitalism on the page “Arthritis” which states:
“homeopathic medicine. NDs use diluted doses of natural substances (plants, animals and minerals) to stimulate the body’s vital force and promote self-healing […] traditional Chinese medicine. TCM is used by NDs to help balance qi (energy flow) to reduce illness and promote health.”
How ethical?
How philosophical?
How pseudo!
A 2019 Paper.
This paper is rather short, about 7 ½ double-spaced pages in TNR 12 point.
I will include a recitation of its references at the end of the next and last section of this Episode 015 Part 2, which is s02e05b3, after reciting the references for the capstone.
With some distance I see errors, both grammatical and typographical, and maybe even strategic, in this paper which was sort of a warm-up for the capstone.
M7A1: IM in CM Case Study Analysis
Robert Cullen
Excelsior College
HSC518 Ethics and Healthcare
Professor Foederer
March 3, 2019
The activities, beliefs and claims of Integrative Medicine [IM], a recent rebranding of the area often referred to as Complementary and Alternative Medicine [CAM] (Morrison, 2016, p.125), particularly when housed within a larger, mainstream academic healthcare system, pose intriguing ethical hazards and dilemmas for the uninformed and/or credulous healthcare administrator or executive.
Healthcare has, broadly speaking, an overall goal of quality improvement within such common stipulations as collaboration, transparency, truthfulness, integrity and equity (NAHQ, 2019). Here, such mainstream goals and stipulations will be represented with the abbreviation CM [conventional medicine]. In light of such a progressive and standard mission, recently, the study “Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients with Curable Cancer”, published in JAMA Oncology (Johnson, 2018), surprising found that with greater patient use of IM/CAM there was an associated 2-fold increased risk of death from curable cancers when compared to populations that did not use IM/CAM due to patient refusal of typical / conventional CM care.
Morrison's textbook Ethics in Healthcare Administration considers IM/CAM to be “an eclectic collection of philosophies and practices” (Morrison, 2016, p.125). This short case study analysis will argue that IM/CAM and CM have vastly different philosophical assumptions, standards and methodologies, philosophical in the sense of encompassing both epistemological and ethical foundations, which all then inform and some may say disinform respective activities and claims therefore potentially explaining IM/CAM's retrograde effect upon quality and efficacy.
Since the IM footprint is quite vague, in fact Morrison states IM is comprised of more than 200 “areas” (Morrison, 2016, p.129), this case study will focus on one area that Morrison mentions within IM, naturopathy. Regarding naturopathy, Morrison asserts "there is a program for school accreditation and individual certification/ licensure for acupuncture and naturopathy practice" (Morrison, 2016, p.129). But, is the existence of such a “program” any guarantee of the integrity of this area of IM when that North American naturopathy licensure exam, NPLEX, quite falsely places the science-ejected category homeopathy within its “clinical sciences” section? (NABNE, 2019; AGDH, 2015).
The example institution for this case study, to demonstrate IM-CM hazards and dilemmas, is the George Washington University Center for Integrative Medicine within the George Washington University Medical Center -- GWUCIM, GWUMC respectively. Under an IM-CAM umbrella, their cornucopia and perhaps one may say nebulosity includes:
integrative medicine consultations, naturopathic medicine, holistic psychiatry and psychotherapy, nutritional counseling, integrative health coaching, European mistletoe injection therapy, mindfulness-based stress reduction, reiki, yoga, holistic primary care, genetic profile results interpretation, intravenous therapies (high dose vitamin c, phosphatidylcholine, Myers cocktail, glutathione), biofeedback, Alexander technique, craniosacral osteopathic manipulation, massage therapy, hypnotherapy, bioidentical hormone replacement therapy, body composition testing, indoor environmental consulting by Insitu, women’s health and holistic gynecology, naturopathic integrative oncology services, natural product store, mind-body medicine, infrared light therapy, integrative geriatrics (GWUCIM, 2019, Patient care services).
The naturopathy page for the institution states naturopathic methods include homeopathy, that it is a patient-centered, distinct primary health care profession whose members are “trained as primary care doctors at accredited four-year naturopathic medical schools”, is based upon the healing power of nature or vis medicatrix naturae, and that it “combines modern scientific knowledge with traditional and natural forms of medicine” (GWUCIM, 2019, Naturopathic medicine). The two NDs listed there are Orceyre and Ledenac, with the former a graduate of National University of Natural Medicine who uses homeopathy and states she is medically trained, and the latter a Canadian College of Naturopathic Medicine graduate who also states she is medically trained and also uses homeopathy as a treatment. ND Ledenac's biography page then directs those interested to the aforementioned naturopathy page at the institution. Incidentally, Morrison's section on IM inexplicably adopts the label “allopathic” for CM (Morrison, 2016, p.127). That term was invented by homeopathy's founder in 1800 to describe the prescientific CM of his day and is generally considered to be a pejorative misnomer when applied to modern CM by fringe sectarian “areas” (Weatherall, 1996).
At the alma maters of the two NDs at GWUCIM, NUNM and CCNM, one can find the naturopathy component homeopathy contained within the label “science” (NUNM, 2019) which is similar to the ND board exam while, grossly, homeopathy is considered outside of science (AGDH, 2015). This is indicative of a sui generis knowledge-type self-categorizing by naturopathy that is acutely false. Similarly, in the IM-CAM publication the Journal of Alternative and Complementary Medicine, the ND co-authored article “Evidence-Based Medicine and Naturopathy” states:
EBM has been touted as a ‘new paradigm’ and as a corrective for outdated, bad or unscientific practices. Although it may be true that some medical and health practices are not supported by a weight of evidence and that this can lead to harm, it does not follow that doctors, scientists, or any bureaucrats should have a monopoly on the meaning and deployment of evidence […] By imposing EBM, naturopathy is not legitimated according to its own paradigmatic definitions, but rather, is evaluated according to the parameters set by the scientific model resulting in the marginalization and corruption of ‘traditional naturopathic knowledge’ […] Naturopathy, a Western nonbiomedical ethnomedicine is based on holistic and vitalistic principles whereas biomedicine, the prevailing ethnomedicine is based on scientific reductionist principles. Given such extensive difference it is inappropriate to superimpose reductionist methodologies that are paradigmatically incongruent with the holistic practice of naturopathy (Jagtenberg, 2006).
Obviously, part of the naturopathic agenda is a redefinition of the footprint of science to better accommodate, as opposed to discard due to advancements, its activities, beliefs and claims.
IM also desires to have its own unique or sui generis ideas regarding ethics. This is evident in the article “Ethics and Integrative Medicine: Moving Beyond the Biomedical Model” from the journal Alternative Therapies in Health & Medicine. There, we're told by David E. Guinn, lawyer and [ironically] PhD of “Moral and Political Philosophy and Philosophy of Law”:
Those who have written on the ethics of complementary and alternative medicine (CAM) and integrative medicine have attempted simply to apply traditional bioethics (in the form of principles of autonomy, beneficence, nonmaleficence, and justice) to this new area of healthcare. In this article I argue that adopting the practices of CAM requires a new ethical understanding that incorporates the values implicit in those practices (Guinn, 2001).
So, amazingly, and perhaps bizarrely, not only does IM argue for its own peculiar definition of science, but also its own peculiar though undefined definition of ethics. These positions, in my opinion, are narrow, obscure, unjustifiable, regressive, and often hidden. It is the opposite of CM's goals and stipulations, which previously were listed as universal, and geared toward improvement, collaboration, transparency, truthfulness, integrity and equity.
Specifically, in terms of those opposite IM characteristics so cleverly unmentioned, the GWUCIM has the page “About Integrative Medicine”, containing a link to their naturopathy page. That page does not contain the root scien- nor the root ethic- and mildly states “within our Center, integrative, complementary, or alternative medicine and modalities are distinct from Western, conventional, or allopathic medicine” (GWUMC, 2019, Integrative medicine). A site search of GW through google.com via >site:gwcim.com ethic< does not produce a code of conduct or ethical code for their IM area. To reiterate that reality: a major academic medical institution that contains a collection of areas marketed as Integrative Medicine that do not adhere to the standard boundaries that typify science, medicine and healthcare ethics does not alert the public to its peculiar positions in a simple, understandable, and straightforward manner.
Instead, actually, GWUCIM states:
Integrative Medicine is defined as the practice of healing in a medical environment where the emphasis is on the integrative use of complementary alternative modalities along with conventional treatments to promote one’s natural ability to heal, thus achieving wellness (GWUCIM, 2019, Integrative medicine consultations).
The claim or context is posed as “medical”, as if what occurs in IM happens within mainstream medical boundaries, conduct codes, and epistemological and ethical context. Their NDs also stated “medical.” Yet, for instance, if one refers back to the naturopathy schools which graduated the naturopaths at GW, and to the previous Jagtenberg quote, “natural ability to heal” or vis medicatrix naturae is actually IM’s pedestrian verbiage or coding for the historically science-ejected concept of vitalism (Bechtel, 1998). Vis medicatrix naturae, which is a commitment to the doctrine of an invisible vital or life force running the body that is not in evidence and is also science-discarded, is historically categorized as sectarian (Popular Science, 1890).
Regarding what “medical” thinks of naturopathy, from a state that has licensed naturopathy since 1920, Connecticut (Naturopathic Diaries, 2018), the medical associations have opined. Contrary to IM’s apparently nonexistent guardrails, Connecticut's Fairfield County Medical Association states “all members must subscribe to the Principles of Medical Ethics of the American Medical Association and must not hold themselves out as practitioners of sectarian medicine” (FCMA, 2019). And specifically, regarding IM’s naturopathy, the Connecticut State Medical Society has testimony publicly available that states:
our naturopathic colleagues openly spurn both evidence-based and science-based knowledge and therapeutics [...] we remain concerned that patients will be confused and misled by providers who are neither true believers in naturopathy nor committed practitioners of the science-based medicine that has been the foundation of medical practice for doctors of medicine (MD) and doctors of osteopathy (DO) ever since Flexner set down his guidelines more than 110 years ago (CSMS, 2018).
Usually, an ethical dilemma is quite downstream from foundational assumptions, mannerisms, and perspectives. In that sense, the playing field is established, along with a set of rules. This then allows for productive discourse. The IM in CM situation instead demonstrates two mutually exclusive worldviews that do not have such commonalities which could then allow for fair deliberation of an ethical or factual issue to occur. The Connecticut county and state medical associations’ pronouncements obviously illustrate IM via naturopathy to be incompatible with the CM hallmarks of quality improvement, collaboration, transparency, truthfulness, integrity and equity. Yet, one is trading off the status of another, namely IM is not holding itself to the rigors, methods and foundations of CM in its activities, beliefs and claims yet IM positions itself within a CM wrapping of “medical” for its benefit. Some may remark that this is akin to a bait-and-switch and is a retrograde overall effect in terms of progress along many healthcare fronts.
IM, apparently, as found through its literature and omissions, seeks to keep the public, patients and inevitably healthcare administrators or executives uninformed and/or regards them as credulous. Therein, fundamentally, informed consent, within the ethical principle of autonomy, is quite trampled upon. How does the public benefit from false positions claimed to be true, such as science-based non-science? How does the public benefit when a diagnostic and therapeutic area does not occur within what is commonly expected ethically and factually speaking yet is housed or camouflaged within such assumptions? IM within a mainstream academic setting, as illustrated by naturopathy within GWU, is largely both a hazard and a danger ethically and epistemically speaking.
It would be an act of great credulity to make typical assumptions about IM in terms of quality, integrity, transparency, truthfulness, and equity. Contrary to IM's epistemic and ethical deviance or sui generis footprint, allied healthcare codes of ethics at every level quite explicitly occur within mainstream contexts and are not ahistorical. Until IM states its explicit and bizarre epistemic and ethical deviance up front, and then justifies the utility of that context, I do not believe the business of IM should occur within mainstream allied healthcare.
The Code of Ethics of the American College of Healthcare
Executives states “healthcare executives […must] provide prospective patients
and others with adequate and accurate information, enabling them to make
enlightened decisions regarding services” (ACHE, 2017). In terms of just how
'down the rabbit hole IM within CM truly is', as paraphrased from the physicist
Wolfgang Pauli, “this isn't right. This isn't even wrong” (Prochnow,
1966). IM in CM will not be right, will
not be assessable, until it agrees to the same playing field and rules as all
other areas of modern healthcare.
[not verbalized in the mp3] References
American College of Healthcare Executives. (2017). Code of ethics. Retrieved from https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics
Australian Government Department of Health. (2015). Review of the Australian Government rebate on natural therapies for private insurance. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/0E9129B3574FCA53CA257BF0001ACD11/$File/Natural%20Therapies%20Overview%20Report%20Final%20with%20copyright%2011%20March.pdf
Bechtel, W., & Richardson, R. (1998). Vitalism. Retrieved February 27, 2019, from https://mechanism.ucsd.edu/teaching/philbio/vitalism.htm
Canadian College of Naturopathic Medicine. (2019). NPLEX 2 prep course. Retrieved from https://www.ccnm.edu/nd-careers/continuing-education/on-demand/nplex-2-prep-course
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