Epistemology of naturopathic medicine: toward a model of clinical investigation culminating in transformative experience
When we understand that man is the only animal who must create meaning,
who must open a wedge into neutral nature, we already understand the
essence of love. Love is the problem of an animal who must find life,
create a dialogue with nature in order to experience his own being.
--Ernest Becker (1)
And through this dialogue naturopathic physicians continue an enduring quest for their source of medical knowledge and understanding of human health. Informed by six guiding ethical principles, a naturopathic epistemology--i.e., a naturopathic understanding of the nature and origin of knowledge-arises through an implicit, dynamic relationship with Nature. Such is embodied partly through a vital link with non-human animals (NHA) that has for the past century been threatened by the perseverance of non-human animal biomedical research (NHABR) and its attendant "external locus" of health production.
This relationship with Nature also manifests in a human connection with ourselves in so far as we too exist as "natural" beings. In practical terms we better grasp this link through the pursuit and development of an "internally located"--i.e. human-centered--means of deriving pertinent information, i.e., clinical research. By extension, such investigation allows human "self" research in which physicians' own experience of medicine completes their epistemological quest.
In this way naturopathic physicians will reach a penultimate goal: the assurance of a transformative process by which they add to the "spirit of the world" at a time when their profession is in danger of losing its identity.
A Subtle Base in Principle
Joe Pizzorno, ND notes the imminent danger facing the naturopathic medical profession should its members neglect the importance of clinical research. He says: If the Naturopathic medical profession does not become proactive in developing new strategies for documenting the effectiveness of our medicine [such as] ... methods of clinical investigation we risk losing our identity within the American healthcare system (Joe Pizzorno, personal communication, 11/14/04)
Indeed, naturopathic physicians--like other healthcare practitioners--have available two major traditiona/means of inquiry into the fundamental meaning of human health: clinical research (informed by clinical practice) and non-human animal biomedical experimentation (NHABR). (2)
However, I argue that although naturopathic physicians are beginning to rely upon NHABR in increasing amounts, a research paradigm founded upon clinical experience will allow the profession to maintain a distinctive identity notable for successfully elucidating its epistemological orientation.
This journey commences within a singular, cultivated landscape, that is, one nourished by the six philosophical tenets developed with the 1985 formation of the American Association of Naturopathic Physicians: (3)
1. Vis Medicatrix Naturae (The Healing Power of Nature)
2. Primum Non Nocere (First, Do No Harm)
3. Docere (Doctor as Teacher)
4. Tolle Causum (Treat the Underlying Cause of Disease)
5. Treat the Whole Person
Such tenets mold not only the personal experience of naturopathic physicians within the world--and the ways in which they assist patients in healing--but they comprise the first step in distinguishing the naturopathic profession in an increasingly mechanistic and isolative era. However, these principles affixed in their present form against an empty page may not be enough.
The Promise of Relationships
Indeed, despite a seeming completeness, these tenets may imply a seventh that underpins the others. Simply named, it would read: "Honor Relationships." Though this may appear a trite late 20th century mantra, it rather underscores a concept that Nature itself is embodied in a reverence for relationships. Remembering this principle will serve naturopaths well in advancing the profession.
The theme of relationship flavors the work of Kenneth Vaux who writes on biomedical ethics. He provides important insight into the genesis and maintenance of ethical "insight" in describing three sources impinging upon any decision-making process (in our case the illumination of a naturopathic epistemology). He posits the existence of retrospective, introspective, and "prespective" insight that correspond to the ideas of past, present, and future factors informing our actions.
A retrospective insight provides a powerful reminder of our essential link with "God." Introspective insight describes the process by which humans act simply along the lines of common sense enriched with an overall faith in the worth of other humans. Prespective insight describes an instinctual regard for those who will be affected by our actions. (4)
A naturopathic interpretation of these axes would read as follows: retrospective insight implies that humans have a vital, dynamic tie with Nature; introspective insight directs physicians to conduct scientific research in a manner that is respectful of fellow human beings and NHA; "Prespective" insight here demands that we consider any future effects of various types of research on the natural world generally, fellow humans, and NHA.
These three vectors intersect upon a fundamental theme: regardless of the type of knowledge that naturopathic physicians seek, what matters most is that relationships between and among beings is held in the highest regard. That is to say, naturopathic epistemology does not demand a particular type of knowledge, but rather the way it is gained. Naturopathic physicians are not simply so-called because they supposedly derive their medicines from "Nature," but also because they recognize the sacred essence of that source. They search, mindful of the connectedness between humans, between NHA and humans, and between humans and the natural world.
In fact, a naturopathic rejection of NHABR--which arguably entails a violation of Nature, i.e. our relationship with other creatures--and an embrace of clinical research define the wellspring of naturopathic medical knowledge founded upon the naturopathic philosophical tenets. Of particular importance to both concepts is the dubious "external locus of health" implied in NHABR in contrast with the more appropriate "internal locus of health" ensured by reliance upon clinical experience.
Non-Human Animal Biomedical Research: An External Locus of Health
A Weighty Legacy
Naturopathic physicians must reject NHABR because it threatens our connection with the natural world symbolized by non-human animals and thus a naturopathic epistemology. This threat is dual in that it:
1. Questions the correctness of using NHA as models of human health as part of a scientific argument against NHABR
2. Summons the vehement historical opposition to NHABR voiced by past and contemporary naturopathic physicians thus forming an ethical argument against NHABR as harmful, divisive, and desensitizing to human feeling
Needless to say, "conventional medicine"--and to an increasing extent other healthcare fields--still places the brunt of its resources into NHABR as a means of medical inquiry. (5) Such began with the work of the Greek Galen and continued through the birth of modern physiology with Claude Bernard in the late 1800s. (6)
Interestingly, naturopathic medical students have apparently adopted the paradigm of NHABR in significant numbers. Thirty percent of students and faculty at the National College of Naturopathic Medicine (NCNM) feel that NHABR has contributed significantly to naturopathic medicine (Richard Krebs, Survey of Students' Attitudes Toward Non-Human Animal Biomedical Research, [unpublished, 2002]). This notwithstanding, 74% of students and staff disagreed that NHABR should not be discussed. Finally, regardless of polemical attitudes, few students' or faculty members' attitudes changed while at NCNM.
Perhaps a drift of the naturopathic profession toward "conventional" thinking may explain this relatively strong support of NHABR among naturopathic students and faculty. Yet an argument that exposes the fundamental inadequacy of NHABR such as presented herein may in fact cause these individuals pause.
Challenging the scientific basis of NHABR--ably done by both conventional and naturopathic physicians--comprises the first aspect of this argument.
Challenging NHABR on the Grounds of Science
Modern medical doctors raise the stakes of this challenge to NHABR on several levels: an incongruence in physiological processes between human and NHA as well as the inadequacy of NHA as "models."