Vaccines, Vitalism and Vacillation

In response to the post below, the AANP has made significant changes to the webinar. It is no longer listed on the AANP website and appears to only be accessible via an older direct link. It has been significantly retitled and the title indicates it is now closed to new registrations. The webinar now comes with a disclaimer that it does not reflect current practices recommended by the ACIP/CDC. It notes that AANP hosting the webinar does not suggest endorsement. Pro-vaccine talks (adhering to mainstream medical standards of vaccine practice), from the 2018 AANP convention, are included along with the webinar. And, continuing education units are no longer mentioned as offered for this webinar..

Original post is below.

In the name of inclusivity the AANP is hosting webinars from NMI, a group that holds that naturopathy must be based in vitalism. NMI uncritically promotes non-evidenced based and anti-vaccination protocols. In approving this webinar for CUs, the AANP handcuffs current naturopathic practice to the errors of the past.

Recently the American Association of Naturopathic Physicians (AANP) elected to grant continuing education credits to an upcoming webinar, The Whole Picture of Vaccination. Described as a collaboration between the AANP and the Naturopathic Medicine Institute (NMI), the initial sentence of the event description asks, “How can naturopathic doctors best work with their patients when it comes to vaccination?” Could NMI possibly be discussing techniques for helping vaccine-hesitant parents choose vaccination?

As it turns out, not a chance. This teleconference showcases sessions focusing on the “Vitalistic Naturopathic Philosophy” used to approach “establishing health” and “creating and supporting healthy immune function”. Attendees will spend 15 minutes on “Homeoprophylaxis as a Clinical Tool” [1]. They will spend a grand 45 minutes on hearing case studies of children being treated for “Childhood Contagious Illness” [2], likely through NMI’s-favored methods of constitutional hydrotherapy, fasting, and homeopathy.

A perusal of freely-available materials published elsewhere by several of the presenters [3], appears to show that they hold that vaccination is both unnecessary and harmful. They believe in vitalism, the theory that the processes of the body are governed by a non-material force that cannot be measured or tested. Furthermore, they appear to believe that most or all of what a provider needs to prevent or treat such illnesses as polio, diphtheria, etc., is:

  • homeopathic preparations,
  • hot and cold water,
  • some electricity,
  • and a (very) light diet (such as restricting the child to basically broth and juice for days on end throughout an illness).

This webinar will thus facilitate providers in discouraging vaccination in their patients; and in discouraging patients from seeking effective treatment should their children become ill with a vaccine-preventable disease.

As has been discussed exhaustively elsewhere, the overwhelming evidence is that vaccination prevents disease. A 2015 Canadian paper noted that “There is little research in the scientific literature to support the effectiveness of nosodes.” [4] Numerous trials have resulted in the conclusion that homeopathy is no more effective than placebo. Constitutional hydrotherapy has not had research in the last 50+ years, with the exception of a recent study in HIV+ patients which showed little or no change in markers of immune function [5]. Thus hydrotherapy has no firm evidence supporting its use for treating infectious disease, case studies not-withstanding. While NMI has the right to promote their views, it’s questionable as to whether or not they should be given a platform and seeming endorsement by the AANP.

As the central national organization for licensed naturopathic doctors in the United States, the AANP’s roles are similar to those of the American Medical Association [6]. A few of these roles include working with governments regarding legislation, serving as a voice for the profession, and “setting the direction” for the profession, including standards of practice. One crucial role for the AANP is providing continuing education for naturopathic doctors. As the national organization for NDs in the United States, the AANP should be setting the bar high for continuing education quality. How then is the AANP, whose site states that they promote “safe and effective treatment” for patients, hosting and promoting this webinar?

One answer may be that as historically naturopathic medicine has embraced a wide range of practices, approaches, and belief systems, the AANP has tended to be reluctant to exclude any particular approach, belief, or set of practices. Thus (as far as this author can determine), it does not require continuing education courses to conform to any standards regarding the content of what is taught. (The AANP does require that there be no commercial bias; financial disclosures are required.)

This is reflected in the AANP form to apply to provide CE courses (available on the AANP’s website. There is no mention, anywhere, of a standard regarding critical evaluation of the content: e.g. what the proposed mechanism is for the protocol, or what evidence supports it. Case studies are not required to conform to such standards as ensuring that the diagnosis was verified. (And case studies are a very low rung on the ladder of evidence.)

And yet such critical evaluation requirements should be a part of any continuing education coursework. Participants should know what the basis is for what they are being taught. They should be able to let patients know the validity of tests and the effectiveness of treatments. Most importantly, what they are being taught should be known to be both safe and effective (allowing for the reality that most, if not all, treatments require balancing risks versus benefits.)

This is reflective of a larger problem: an overall refusal, at the level of the national organization, to critically evaluate long-standing naturopathic approaches and philosophies against what the evidence says regarding their safety and effectiveness. This has been reflected perhaps most strongly in the AANP’S position (or lack of one) on vaccination.

As naturopathic doctors come to play an increasing part in the healthcare scene of the United States and Canada, there has been concern around the issue of how naturopathic care impacts vaccination rates. This is understandable: historically the profession was strongly anti-vaccine in stance. Yet this has changed over the years. The schools now teach the CDC/ACIP schedules, and support vaccination enough that more traditional providers fear that the schools are no longer “teaching traditional naturopathy”.

The reality is that a good number of NDs support vaccination and do not regard it is a ticket to ill-health. While it is true that many of these providers would be classified as “vaccine hesitant” due to offering alternative schedules, or protocols to avert alleged “adverse effects”, it is also true that there is a world of difference between the original naturopathic near-total refusal of vaccines, and the stance of many modern naturopathic practitioners. My impression, from my observation of my own graduating class of 2011, has been that many of my colleagues are actively involved in vaccinating their patients, or in encouraging vaccination. Not a few of us (myself included) actively work to promote vaccination through NDs For Vaccines.

And yet for some years now, the AANP has been unable to produce a working position paper on vaccines - nearly three decades after the original, sort-of-but-not-terribly-pro-vaccine paper was introduced. And while it recently hosted pro-vaccination talks at its convention that would be quite at home at a conventional medical conference [7], it also continues to promote webinars such as The Whole Picture of Vaccination, which discourage vaccination. As the current measles outbreaks in Europe show, lowering vaccine rates can lead to harm for both individuals and the public health at large.

Curiously (in contrast to the AANP) NMI itself has no problem upon standardizing around a core set of approaches and protocols, though these are not evidence based. In video interviews its founding presenters state unabashedly that they hold vitalism to be key to naturopathy. They make it plain that they regard current naturopathic practices that are evidence-based to be “far from the roots” of naturopathic medicine. They talk openly about their disdain for commercial vaccines.

Yet while representing themselves as the true core of naturopathic medicine, the NMI does not represent how the majority of naturopathic doctors think or practice. In fact, the interviews with two of its founders [3] state that they see themselves as a minority, a remnant of the days of original naturopathic practice from before the current resurgence started in the 1980’s. They profess unease with the direction of modern naturopathic education as being too close to that of mainstream/conventional medical education and thought.

It is true that NMI represents an older form of naturopathic practice, rooted in traditional thought and the philosophy called ”nature cure”. But historical fidelity, and purity of philosophy, do not equate to validity of ideas. They do not guarantee safety or effectiveness.

The clinicians of today should not be hobbled by the practices of yesterday. The unproven fears of yesteryear should not be recycled to deprive today’s children of vaccines and proven treatments. And our guiding concern as naturopathic doctors should be the health, safety, and welfare of our patients - not promoting naturopathic medicine, nor staying “true to our roots”.

I sympathize with the AANP’s dilemma in trying to represent the wide-ranging group of naturopathic practitioners in the United States. However, if it is to fulfill its stated intention of promoting safe, effective natural care, it must apply critical evaluation and evidence-based standards for granting its imprimatur for continuing education. This is especially true for issues like vaccination, which affect public health, historically an area of great concern for naturopathic medicine. Otherwise it calls into question where the AANP’s real concern lies: the health of the patients we serve? Or promoting the profession?

Note: While NMI promotes a set of philosophies, not all speakers featured on NMI’s website are vitalists or anti-vaccine. Before drawing conclusions about the views of an individual found there, please research their views.

In response to the post above, the AANP has made significant changes to the webinar. It is no longer listed on the AANP website and appears to only be accessible via an older direct link. It has been significantly retitled and the title indicates it is now closed to new registrations. The webinar now comes with a disclaimer that it does not reflect current practices recommended by the ACIP/CDC. It notes that AANP hosting the webinar does not suggest endorsement. Pro-vaccine talks (adhering to mainstream medical standards of vaccine practice), from the 2018 AANP convention, are included along with the webinar. And, continuing education units are no longer mentioned as offered for this webinar.

[1]: Homeoprophylaxis is the practice of giving homeopathic preparations of pathogens as a substitute for vaccination.

[2]: “Childhood Contagious Illness” is a phrase used in the vitalist community to refer to vaccine-preventable diseases such as polio, diphtheria, pertussis, measles, mumps, meningitis and so forth.

[3]: As examples see “Immunizations/Vaccinations” by Thomas Kruzel ND; http://rockwoodnaturalmedicine.com/pdf/Immunizations.pdf retrieved 08/22/2018; “Back to the Future: Why Vitalism is the New Medicine by Jim Sensenig ND; https://www.naturopathic.org/files/Events/2013%20Conference/sensenig.pdf, retrieved 08/22/2018; Interview: Letitia Dick-Kronenberg ND, https://www.youtube.com/watch?v=6huPt3JAZEo, retrieved 8/22/2018; Interview: Jared Zeff ND https://www.youtube.com/watch?v=Pqj0gDwOEok, retrieved 8/22/2018

[4] Rieder MJ, Robinson JL. “Nosodes” are no substitute for vaccines. Paediatrics & Child Health. 2015;20(4):219-220. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443832/ retrieved 8/24/2018

[5]: See Corroon, J, et al Pilot clinical trial of constitutional hydrotherapy in HIV+ adults, Advances in Integrative Medicine 5 (2018: 23-28) https://www.aimedjournal.com/article/S2212-9588(17)30146-5/pdf retrieved 8/22/2018.

[6]: Please note: neither the AANP nor the AMA are able to remove the licenses of individual providers in response to complaints, nor do they handle those complaints. Those are handled by state boards.

[7]: See: https://aanpconvention.com/sessions/28-days-pediatric-primary-care-in-the-neonatal-period/, https://aanpconvention.com/sessions/practical-tips-for-speaking-to-vaccine-hesitant-parents-addressing-common-concerns-and-misconceptions/, and https://aanpconvention.com/sessions/vaccines-risk-to-benefit-ratios-and-new-evidence/ All speakers at these events are strong pro-vaccine proponents.