Interview: April 28, 2006
Pamela Snider, ND
David Schleich, PhD
Interviewer & Editor: Kathryn Williams, MA
Director of Retail Operations, NCNM
What does it mean to have an academic home for this project? With National College of Naturopathic Medicine (NCNM) serving as your academic home, how, or in what capacity are the other naturopathic colleges involved in the project?
Pamela Snider: NCNM allows this large international project to operate through the academic processes and filters of a college. This means having a base in a college that understands scholarship, and has the resources to support strategic research of the profession’s concepts. It means access to a library with old and rare books, to faculty who teach relevant courses and are involved in writing and researching on the project, and to work study support. It also means having an infrastructure to manage the basic trafficking of finances, developing and maintaining relationships with sponsors, and IRS reporting.
David Schleich: The project needs the credibility of a higher education context, which complements its goal of codifying the profession’s knowledge. NCNM is ideal for many reasons, being the founding naturopathic educational institution for the profession in our time is, of course, high among them.
Snider: We often refer to National College as the “Mother Ship.” It gave birth to each of the other colleges. The intention of the Foundations Project and of NCNM is to be completely collaborative with the other schools. Out of the 150 contributing authors, we have a solid number writing from every college in North America. We also have contributors from colleges in the UK, New Zealand, and Australia. We just got an author from Israel; National College has a great spirit about this collaboration and visibility being equal and shared.
Is the main way you are connecting with other colleges through the faculty? Are there alternate ways that the other colleges will be influencing this project?
We have visited each college in North America. We have met with their faculties, deans, and presidents, have invited them to participate, and have asked for their advice. In fact, the text’s shape and design were generated out of existing writings of faculty, clinicians, research scientists and other colleagues. For the last 15 years, we have been monitoring the profession’s scholarship on philosophy and clinical theory, and tracking the conclusions and emerging models faculty and clinicians in the field have developed. We also will be inviting faculty from every school, along with our lead participants, co-leads,, editors, agency liaisons, student representatives, and thought leaders from other disciplines, to our symposium in 2007 where they will help finalize the core ideas and coherence of the textbook.
The Foundations Project is so much more than a textbook writing process, it is dynamic and ongoing; it seems to be the initiation of serious academic scholarship within the profession. Would you say this project is giving the profession academic credibility, providing more incentive for faculty to participate in scholarship?
Snider: While the profession has been generating academic credibility for many years, this project ramps up that process and gives it a higher visibility at a critical moment. It is so essential that we support our faculty in this field. The range, depth, and quality of knowledge are extraordinary in our faculty, researchers, and our practicing doctors. They need the time to actually do their research, to write, think, and to engage with other disciplines, not just our own, in order to develop the rigor and fine tuning of real critical thinking, the ability to communicate what we are with rigor. We are on the brink of a strategic breakthrough. We are in some ways heralded by the profession’s developing research focus and agenda. It could certainly be much more deeply supported and needs to be. The leaders in the research community, Dr. Calabrese, Dr. Standish, Dr. Zwickey, Dr. Kail, and others throughout the profession are the trailblazers and teachers who have led us to the current level of naturopathic research. We now need to do that with other kinds of scholarship. Many of our doctors write textbooks about certain aspects of health, orthopedics, women’s health, and how to treat conditions, but the actual foundations of the medicine and the key concepts need to be recorded and published. This is a new kind of collective scholarship.
What is the Foundations Project birth story?
Snider: It was born in so many ways; it has had a hundred births. In a way it was birthed with the profession in 1905 when naturopathic medicine began to define its healing concepts through early writers—Lust, Lindlhar, even Samual Hahnemann and his writings on homeopathic medicine before naturopathic medicine. Many contributors and thought leaders then and now have leavened the dialogue, adding amplitude to the contractions. For me personally, along with senior editor Dr. Jared Zeff, the Foundations Project began its journey with the AANP in 1989 when it defined the principles of naturopathic medicine. Once the profession defined its principles, the question left on the table was, where is the flesh on the bone? These are the bones, but where is our body, what is our body as a field, what is the heart of the medicine, the full flower, as Bill Mitchell, ND would call it?
The fellowship emerged; the conversation emerged within the profession naturally, as it should. As Dr. Jim Sensenig was doing his teaching, as Dr. Jared Zeff, myself and many other naturopathic philosophy teachers were communicating the laws of healing, theory, and philosophy, we began to notice that our varied models and ways of talking about the concepts actually represented the full presentation of philosophy today. Not one part, but all of it made the full taxonomy of the philosophy. They weren’t disparate parts. Put together they made something coherent, more powerful, and more effective than each part alone.
Another turning point was Dr. Zeff’s seminal article, “Process of Healing,” in a 1996 Journal of Naturopathic Medicine. When he published that and the AANP convened a plenary session with an open mike on Toward a Unifying Theory of Naturopathic Medicine, Dr. Bill Mitchell, one of the legendary philosophy teachers, Dr. Zeff, Dr. Sensenig and myself came together to talk with the profession about moving toward a unifying theory. One of the declarations we made at that conference was to start the integration project, which meant a conversation among faculty, a lot of meetings, and a lot of work to integrate the philosophy throughout the curriculum, across all the schools. Primarily unfunded; frequently supported by Bastyr, and the Association of Accredited Natural Medical College’s (AANMC) Dean’s Council, this effort lasted about 10 years: responding to, synergizing with, and spurring new levels of scholarship among the college’s faculty. We were sharing our ideas, and the ideas that made the most sense began to fall into place naturally, as we created our courses and developed our other writing. That was an early part of the birth.
How big was that “we”?
Snider: That “we” was probably 60 to 80 faculty and physicians who participated in the work and the meetings over the years across the profession. The Integration Project ran through the Dean’s Council of the AANMC and was inaugurated into the colleges with a college-wide survey in 1996. Involved faculty would periodically convene at conventions, or in groups at their respective campuses to explore these concepts.
Dr. Snider, were you the one that said let’s create a foundations of naturopathic medicine text?
Snider: Yes and no. That part of the birth occurred between Dr. Zeff and me. Different publishers approached each of us simultaneously about writing a textbook of naturopathic medicine or naturopathic philosophy. We have long been partners, working very closely together on philosophy, collaborating and teaching together on many aspects of theory and its development. We consulted with one another, as well as with Dr. Joe Pizzorno on our individual books and finally decided the three of us would work together. We then decided to ask Dr. Jim Sensenig, knowing we wouldn’t write a textbook on naturopathic philosophy without him. All of us had been involved in the Integration Project for over 10 years, exploring each other’s ideas and how they came together into a coherent philosophy. We looked around and asked, “how can we leave these other scholars out of this statement?” It would not be valid or engage the very best of our thinking as a field if we don’t include them. That was the turning point.
We looked at additional leadership and began to invite people like Dr. David Schleich , Dr. Tom Kruzel, Dr. Cathy Rogers, Dr. Bill Mitchell, Dr. Stephen Meyers from Australia, Dr. Don Warren from Canada, Dr. Christa Louise, executive director of NPLEX—she wrote her PhD thesis on Complexity Theory and Naturopathic Principles, Dr. Roger Newman Turner from the UK—a legend in the UK in naturopathic medicine, and more, Dr. William Keppler, a public health scholar and academic leader, Dr. Rita Bettenburg, the dean of naturopathic medicine at NCNM, Chris Grontkowski, PhD in the Philosophy of Science, and Dr. Eric Blake, our history editor from NCNM. We came together to look at the foundations of our knowledge, which really haven’t been updated in a profession- wide textbook based on philosophy in 90 years.
We then began to communicate with the agencies in the profession to address, incorporate, and respect professional standards and issues in different countries, information essential for us not to misrepresent or overlook, as well as to implement the recommendations of the Naturopathic Medical Research Agenda (NMRA) on operationalizing our theory for research purposes. Finally, we have a series of section co-leads working closely with our editorial team. I hope I didn’t leave anyone out.
Your slogan, “Codifying Our Knowledge,” points to an array of therapeutic approaches and interpretations. How will you join these into a viable code and effectively convey it, given the number of contributors and points of view in the profession?
Snider: Ten years ago, I don’t think it would have been possible. We weren’t ready as a field. We needed time for different thinkers to bring forward their own works, their own ways of interpreting the philosophy. What is stunning, and is the wind in my sails, is the philosophical coherence we have seen at each college we have visited. In talking with faculty at each college, we were ecstatic to discover that there was a natural coherence re-emerging out of the way naturopathic physicians think about healing today. The way we apply theory is fundamentally similar regardless of our independent practice. It’s the way we talk about it and the rigor with which we communicate it that needs to be improved and brought into more focus. That has been one of the most beautiful discoveries in writing this textbook, that we really do have what I call a genome. The people who came to this field actually carry the code. And so, we have to bring it out of them and evaluate it against the rigor of other disciplines and the rigor of other ideas and critical thinking. There is a validity that is emerging in the natural resonance of the field; that is when clinical theory and philosophy make sense. There is also an extraordinary exploration of cosmology going on among many of our scholars
What do you mean by cosmology?
Snider: In thinking about philosophy, principles, and theory, it is easy to interchange those words, but really, they are distinct elements of a discipline. Philosophy is the rational investigation of the truth. Cosmology is a broad ranging inquiry about life, the universe, what it means. Principles are rules of conduct, declarations you can put in a list. They do not make a clinically applicable system. Theory is when you take all of that and make it something systematic. A great example is Chinese medicine’s five-element theory. It is a system that is described and then there are clinical applications of that system, and clinical decisions and pathways of clinical thinking that come from the theory. Those three areas need to be correlated into one coherent whole and then applied to the field.
Naturopathic physicians think in different ways. Some think in terms of principles, some in terms of theory. I tend to be more of a clinical theorist, as does Dr. Zeff; Dr. Sensenig comes from a more cosmological perspective. We have made space in our text for all of this to come together and be edited into a coherent whole.
Our editors’ sources for this are the early works of naturopathic philosophy. We’re not reinventing this field or its philosophy. We are moving it forward to where it needs to be today. We are deeply committed and passionate about maintaining the traditions of naturopathic medicine, while bringing them into a modern rigor, into interaction with today’s ideas.
A great example is the unity of disease theory that Lindlahr writes about in Nature Cure. The alignment of that theory, the underlying unity of inflammation across all chronic disease, as a positive core factor is actually being re-described in today’s scientific literature, especially in the research on cardiovascular disease and diabetes. It is reemerging today as the exact theory Lindlahr established a hundred years ago, but with modern evidence and modern language. We have heard it presented and are watching it in the literature and we will be presenting this in the text as an update on Lindlahr’s ideas. This is one great example; every naturopathic physician is aware of that literature.
This is such strong evidence that naturopathic medicine is growing and evolving, capable of keeping pace with other health disciplines.
Schleich: The literature of the professions suggests that among the complementary and alternative medicine (C.A.M.) providers, naturopathic doctors are truly on a cusp right now.
You have touched on this, but can you say more about the process of choosing participating authors?
Snider: First, I should have said at the outset that our publisher is Elsevier. Without them, we would not be here. They are enthusiastic about this project and its evolution from a smaller text to a larger more scholarly text. I want to acknowledge their interest in our more global communication of what naturopathic medicine is.
How we selected authors . . . honestly, as the co-chair of the Integration Project for many years, I kept files on everybody’s work in the field, as I knew it. Occasionally, however, I am chagrined to find an author I have missed and think, “how could I not have called that person?” I go hat in hand and see if they will join us. Anybody out there who has written something relevant and reads this, I am already apologizing. The way we went about it was by looking at the works that had emerged– Basically, by taking out all of my files and laying them out across my bed and tables and categorizing them and then summarizing them in lists, categories, and types of subjects. Out of that came the text’s format. Dr. Zeff, Dr. Pizzorno, Dr. Sensenig, and I wrote the first outline, and then submitted it to Elsevier. As we decided to involve many authors, we began to look at all the works and fill in the blanks. We had a four-page outline that turned into 40 pages. It has been an inductive process arising from the heart of the field.
With naturopaths practicing throughout the world, communication for this project is key. I understand that you have access to an online platform at NCNM called Moodle. What are your plans for implementing this tool?
Snider: We are in the mid-construction phase. This gift from NCNM, the Moodle platform, is critical to the success of the project. This long-term project is about articulating the foundations of naturopathic medicine over time. So, building an online virtual learning community with the first edition of the textbook will begin a sustained mode of communication through future editions as we revise and republish the text every five years. This will allow scholarship to develop online in small groups who are writing a chapter together, as well as large groups who are reviewing a key statement like, what is naturopathic primary care, or what is the process of healing, or what does a clinical algorithm look like, with the philosophy decisions integrated into it. We hope within a month to be loading author teams up onto Moodle. Currently, we have several pilot groups using it.
That is exciting. It will be good to hear more as that develops.
Snider: Research on virtual learning environments says that these environments are among the most efficient ways to transform a culture. With our limited budget, being able to work online with each other across six countries will enable a much more rapid coherence and rigor to develop.
What would you say is the most rewarding thing that has come out of this project so far?
Snider: One is that our editorial team is an extraordinary group of leaders. I find it a gift to work with that team.
What have you received from working with this team?
Snider: First, these are all seasoned leaders, scholars, deep, wise knowers of naturopathic medicine on many, many levels. Every one of our editors, all 16 of them, are strong, independent thinkers, and every one of them is very collaborative with each other, very respectful. Their work is toward the common mission. It is not about themselves as individuals.
The other gift is the profession itself. As I said earlier, the wind in my sails is how our knowing of the philosophy of naturopathic medicine is actually more coherent than we realize. Moreover, our speaking of it is improving—our commonness in speaking of it. Finally, the passion that people are stepping forward with, offering their work, their joy that it is happening, and how powerfully moved they are to be involved.
Schleich: I like Pam’s metaphor about sails. We do have sails. There is traction; there is momentum.
However, the formation of professions is a ruthless process. There is no benevolent means for forming professions. Codifying the specialized knowledge of a professional group, though, can ameliorate that ruthlessness. The cranky way in which other professions resist the emergence of a new one in their midst can distract clinicians and the scholars of that profession. The nature of professional formation has to do with economic territoriality, political territoriality certainly, but its momentum comes from a belief in one’s own profession’s clinical approach to healing. There is huge competition within natural health. Allopathic practitioners, those Dr. Hans Baer would describe as the dominant American biomedical doctors, are not going to relinquish the stranglehold they have on most of the third party payments in the country— or in Canada, their domination of the public health system and what few third party providers there are.
At this time in North America, the naturopathic profession has a real chance, a window, to form formally. The conscious approach toward state regulation now occurring is very different than earlier regulatory efforts. For example, in the province of Alberta, a new province of what was then called the “dominion” of Canada back in the middle of the last century, there was an act called the Naturopathy Act of 1952, which was unsettled because the profession had not done its homework on codifying its knowledge and educating the next generation. The same was true in Texas. There was a time when there were several hundred naturopathic doctors there and now there are fewer than a dozen.
There are many examples of this. How is it that the chiropractic profession was able by 1978 to have regulatory presence in every state in the United States and every province in Canada? The answer is they were deliberate about assembling their knowledge in the forms acceptable to the higher education community and the time.
There are those in the medical community who would disparage some of that, but the point is they did it. It is no accident that in Canada right now in the province of Ontario, the Canadian Memorial Chiropractic College has been given permission for the first time in Canada’s history to offer a degree of Doctor of Chiropractic Medicine. That is not happening quite so handily for the naturopathic profession in Ontario.
There are now many naturopathic physicians, regulated and licensed, who are writing, who are codifying, assembling, and discussing their knowledge, clinical and theoretical. It is a great gift to be a student of these processes, to see how close the naturopathic profession is to crossing the Rubicon. It is very real, very possible.
The writing and scholarship are key in this process. To promote writing and scholarship in the profession have you considered publishing a professional journal as another way to perpetuate and maintain the academic conversation between the textbook editions?
Schleich: Yes, it is inevitable that there will be serial publications that are refereed and others that are perhaps more statements of curriculum rather than evidence-based case studies. It is inevitable because people will become accustomed to talking about what they are doing.
My wife for example is currently writing 50 case studies in a therapy called Buteyko, a non-invasive therapy, treatment for respiratory problems. She is taking time to write about it so that others who can’t come to her seminars can benefit from her knowledge. There are hundreds of people out there now, not 10 or a dozen, but several hundred people who are doing that on a regular basis.
With regard to promoting scholarly writing, there are other spin-offs. One of them is the serial publication, for example, the ND News & Review. It is probably one of the highest quality serial publications that does not profess to be an academic journal. It is meant to be a platform for sharing information. But the quality is very high. ND News & Review is achieving that because the quality of input is very high, and the editorial staff is taking time to make sure that the quality is maintained.
We fully intend through the Foundations Project to stimulate in the colleges and in other institutions ways to support and fund sabbaticals allowing faculty members and other naturopathic professionals the financial means to write. “Release” time is rare. In fact, note the very term “release.” From what? From teaching and administrative duties. In an ideal world, it’s not about “release,” it’s about balance among these important tasks.
Snider: Typically our faculty and our deans and department chairs, everyone on salaries or practicing in a clinic is busy full-time with the things that bring in the revenue that support the college’s function, and naturopathic programs don’t typically have faculty release time. We want to foster these ideas and help support faculty release time becoming a reality: that is a priority in the minds of the colleges. It’s a resource issue and it’s a focus issue. As policy and research have both been major strategic priorities in the profession, we need now to make scholarship our next strategic priority. It is time.
Schleich: The word strategic is critical here. It is about resources, and it is about strategies. For example, I can’t imagine that it would be tough to raise a couple hundred thousand bucks a year to offset the costs of having somebody freed up every four years to take a year off. Ideally, instead of rotating through the colleges, it needs to be done at all of them. There are various ways to spin it as being about cash flow.
There are many ways to spin resources. For example, take professor A: you say to him or her, you will get three quarters of your salary for three years, and in the fourth year you will get three quarters of your salary but you won’t have an assignment. That year is your own. The Foundations Project comes along, and we say we’re going to top off that three quarters with one quarter each of those four years. That turns into one salary for one year, but it comes in little pieces. So you can then do four at once rather than only one.
Snider: One of the strong desires of our editors is to foster other textbooks in the profession, books that build on the information in the Foundations textbook. We want to provide a platform, a unified voice, unified meaning, and unified presentation of ideas about our clinical theory based on diverse views of those ideas. Diversity and coherence can live well together in scholarship.
We will present diverse views on concepts when it’s relevant, when it is good scholarship, when it is good critical inquiry, because between this edition and the next, the diversity within the conversation will ultimately lead to more coherence between us, and better working models. The goal is for future students and faculty to have models and ways to talk about our ideas that still leave enough freedom for new ideas and perspectives, while creating a common presentation about theory.
I have wondered how this project will help unify the philosophical conflicts that occur in this profession. It sounds like you are working it through, and that collaboration, and coherence blended with a willingness to receive different points of view is the answer.
Snider: And to be in the process. It’s ok in this edition if we don’t all come into agreement or consensus. This isn’t consensus. It’s not possible to achieve consensus on theory. It is possible to achieve coherence, power, rigor, and codification as Dr. Schleich says. I have to tip my hat to Dr. Zeff for the many years he has listened to so many viewpoints and been open to incorporating them into the ideas he writes and teaches about. Some good ideas and changes come out of heated, conflicting dialogues.
It is impressive that the Project is willing and able to take this position within the process of codifying the knowledge of naturopathic medicine.
Snider: We couldn’t really do anything different. Principle seven of naturopathic medicine says, “don’t tell me what to think”. We really do have to know our own individual viewpoints and well represent them.
Opening to the many perspectives in this profession doesn’t take away from codifying the knowledge?
Snider: It doesn’t take it away. We are mature enough as a field, and we talk about this often. The need for unity is as strong as the need for and importance of independent thinking. Independent thinking is part of the heritage and vital force of naturopathic medicine.
Schleich: I want to add to the earlier question about how the academic conversation between editions can be sustained, as in a professional journal.
This project is a great one for achieving that. For example, there could be faculty exchanges, which nourish inter-institutional sharing but also broaden and deepen communication between clinicians and other teachers in the naturopathic system. Exchanges deepen faculty members’ familiarity with the profession’s knowledge. Exchanges are very easy to do. For example, there is a naturopathic program at a prominent University in New South Wales in Australia. That program is an undergraduate program called Bachelor in Naturopathic Medicine. It’s four years long, somewhat different then the North American programs based on the Council on Naturopathic Medical Education (CNME). Some of the modalities are somewhat different also, and the flora is certainly different for botanical medicine options.
There are costs to such dislocations and they could be paid by the Foundations Project with exchanges approved by the institution.
Another way to sustain the conversation is providing release time for degree completion. The professional formation requires more NDs and PhDs per square inch than we have been able to muster so far. I’m not talking about the so-called “doctorates” you get from Clayton, of course. I am talking about higher education degrees from accredited, certified, properly recognized universities in subjects and disciplines of relative interest to the profession’s practitioners and students.
Release time for degree completion is tough, but what you do is develop an inter-professional plan that is part of your ongoing base budget. So if an ND faculty member wanted to do a PhD, her tuition would be paid and she would have certain strategic chunks of time at the right moments to finish it. In return for this, she has to give guaranteed service and so on, and contributions to the profession. Those become part of the operating costs of the institution.
The Foundations Project, if it continues to be a fundraising arm as well through NCNM, can create the money that helps top off the salaries for professional leaves. Because you have to be replaced when you go away, you see. It pays for that. Students’ tuition has historically paid for that and it can’t; that is too much pressure on recurrent tuition revenues.
Another area is Endowed Chairs. Establishing them would be a part of a national campaign. An endowed chair at NCNM would cost $2 million. It includes more than just the person’s salary; it includes the infrastructure supporting that person over time. Therefore, a two million dollar endowment would be for a chair of something, whatever it is, and we need a dozen of them.
Finally, there is the idea of the Symposia. When they occur they will have several layers to them. One of them is a consultative layer where those who haven’t participated can come and be an observer and participate, if you will, in a Grand Rounds about the leading edge of the medicine’s new territory.
These four projects are all do-able. They are do-able for no more than a couple hundred grand a year. You can knock a lot of these off for about $250 to $300 thousand a year. A half million dollars a year would be ideal.
Snider: And fostering the scholarship of the field . . . With the resources we’ve had to work with, we have done incredibly well. Hats are off to our faculty. However, we, the profession, have to take it to a whole new level and define where medicine is going, where the paradigm is moving in the mainstream, and who we are and will be, as these currents are moving in a rapid and amazing way.
Schleich: And a dangerous way.
Snider: And if we point our surfboard toward the old paradigm in order to prove that we are credible, if we continue to point too far backward, we are going to miss the very wave we belong at the leading edge of.
How do you see this project influencing the political struggles involving recognition, like licensure?
Snider: The key issue in professional licensure and policy making throughout the world is providing the answers to the question, what is naturopathic medicine. What we have is college catalogues. What we have are individuals who have written about the field, individual texts, research publications, professional position papers, and we have journal articles.
Those pieces lie within the community. How are we going to get it out so that the mainstream knows what a naturopathic physician is? How will this project facilitate that effort?
Snider: First, when David and I were both involved in the Ontario licensing process, we were told that naturopathic medicine had no body of knowledge. One of the challenges to a field is whether you even have a body of knowledge. During a recent lunch with Cory Resnick, ND, the question was asked: “How does a field define a body of knowledge?” Is it an oral tradition, is it what the doctors do, is there a text that is considered the compendium, the Harrison’s, the Cecil’s of the medicine? Achieving that alone is a huge step forward for us because we will end up with an empowered community of educators who, as they testify, are speaking from a more common and commonly developed voice about naturopathic medicine.
Another key aspect we are also addressing in our textbook is how naturopathic philosophy influences public policy. What are the implications for public policy of the actual philosophy? We’re not just doctors of individual patients; naturopathic philosophy says we also work to create a healthy world. That is one of our principles, it is part of our soul, it is part of who we are as a field, and so the involvement in shaping public policy is a very active part of the field. Strengthening our ability to project that, to communicate, to write about it, to influence it is a huge step forward for us.
The other piece is about science. When we talk about vitalism or the healing power of nature in public venues and can’t explain its meaning with rigor in a way that the interested scientific community in rigorous ways, there is a problem. We have to begin bringing science and our philosophy together. That is another commitment of our textbook.
Our goal is to start asking, “What are the physics behind the healing power of nature?” What does the emerging discipline of complexity science say about holism from a scientific perspective, from an actual clinical application of the idea of chaos theory? What is the research showing, what is the evidence showing, and how do we operationalize something like the idea of the healing crisis? What actually is that biologically that we’re talking about, and what does the research say when we apply a research model to looking at that and finding out if it is biologically true.
Does a clinical impact of suppression exist? What actually is it? We need to ask this type of question in a much more rigorous way than we have before. I have to say that the naturopathic scientific research agenda, which was really launched by Dr. Calabrese and Dr. Standish, with the support of Dr. Konrad Kail and Dr. Michael Traub, brought those questions into focus for our profession. They have initiated bringing the science and philosophy into direct, intentional, rigorous examination.
Schleich: Not too many people in the broad public understand the importance of the naturopathic profession’s long climb to equal player status as primary care physicians. Fogging that lack of interest more are the varying definitions of naturopathic medicine (apart from the AANP definition in 1989, which was developed as a profession-wide position paper) and the presence of other C.A.M. providers with whom that broad public confuses the naturopathic profession. There are various efforts on the part of groups and individuals to define naturopathic medicine and the naturopathic doctor. That will only happen definitively when the branding efforts of the profession are successful. The Foundations Project will enhance positive political outcomes and address the struggles you allude to because of its branding ability. It’s not just the presence of the textbook, it is the activity around it. Representation of naturopathic medicine also needs to be spun with real care by the agencies that are responsible for it as a profession. The Canadian Association of Naturopathic Doctors (CAND), American Association of Naturopathic Physicians (AANP), the CNME, Institute for Natural Medicine (INM), the Northwest Physicians’ Conference, the AANMC , Canadian equivalent associations, NPLEX itself, all of them have to be on board, and they are. They are all establishing liaisons with the Project.
Snider: These organizations are working with us in an important role we call “agency liaisons.” What they are doing is tailored to their missions, which is to represent the standards and quality of the field in each of their agencies core missions. For example, the AANP was the host organization for an enormous national conversation about defining naturopathic medicine based on its philosophy, and will be communicating to us about the resulting position paper, which was passed unanimously by the House of Delegates in 1989. They will make sure that the textbook clearly and correctly represents it as a standard of professional practice in the field. The AANP has a national Guidelines Committee chaired by Ryan Bradley, ND, through the AANP Scientific Affairs Committee. This committee is correlating with us and we are correlating with them to make sure that we are respecting the standards and evolution of the work that is going on internally within the AANP, as well as doing the same with NPLEX. The CAND is communicating with us, updating us on the issues in Canada in terms of scope of practice and the way the ND profession practices there. These factions and distinctions must be reflected carefully in the textbook. Finally, NPLEX, for example, is looking at a new integrative exam and wants to be able to test on the concepts of naturopathic philosophy, but has no textbook in order to do that. So they are very interested in communicating their needs and interacting with us so that the texts can reflect and be useful to their needs. They have very defined roles as agency liaisons which determine how they participate with us.
Schleich: Political struggles are common in every jurisdiction and for every profession. Professional formation is a process well defined by the scholars. Naturopathic medicine must do that too. Naturopathic medicine has to go through the same paroxysms. Several next steps need to happen all at once. That is the nature of professional formation. The convergence of codifying the knowledge goes along at the same time with the regulatory frameworks or policy frameworks that influence practice. At the same time, the institutions that create new practitioners to expand the profession and replace those who are retiring or stepping away from the profession are stabilizing their presence in the traditional higher education realm. By that, I mean it has been a priority for all the American naturopathic colleges to get fully accredited. The Canadian college had a real struggle to get it right, to appreciate why accreditation is so important. Dr. Snider is modest about the remarkable contribution she and her colleagues made back in the early 1990s when CCNM was almost lost to the Heyhurst crowd. There is another kind of accreditation here in the United States. It’s regionally organized, but a federal mandate. In Canada it’s a provincial matter. When I was president of CCNM, there were people who would ask why I was so eager to have the college’s credential under the Ministry of Colleges and Universities. “They are going to interfere; they are going to harm our curriculum.” I would respond by saying, they absolutely will not. We simply needed to position ourselves in a way that would prevent them from diluting our curriculum, assimilating, or marginalizing us. Cherry picking curriculum and modalities is going to happen. It is happening. The way to deal with such dilution is to be the accredited trainer of choice.
Snider: The whole issue of discipline level training verses modality level training is important here. Naturopathic doctors are not trained to practice the full discipline of Oriental medicine. It is very controversial in the United States. At Bastyr University, there is a full TCM program, as NCNM has a full classical Chinese medicine program. As an overall view, naturopathic medicine, as a profession, receives the most arrows for 100 years of incorporating approaches and modalities from many disciplines, like integrative medicine, which many other alternative disciplines perceive as cherry picking.
At its best, integrative medicine, our colleagues, brothers, and sisters in that field are trying to change medicine from the inside–and that is a good thing. In naturopathic medicine a hundred years ago, the profession defined itself based on the concept of integrating the best from world disciplines and traditional systems and modalities of healthcare from many, many systems. This integration was based on the core concept of the vis medicatrix naturae: the healing power of nature. Different people came together from many disciplines to form naturopathic medicine and actually created a core philosophy around which all those different pieces and practices from other systems of care were integrated into a completely new and dynamic field. The problem is that in the United States, and I’m not sure exactly where it now is in Canada, but in the United States some states do include acupuncture in their naturopathic medicine scope of practice. My bias is that when we (any we) are trained in a very small amount in another field, we have to be very careful about collaborating with that field to define how much training is appropriate for practicing a modality level skill of their whole discipline or system…three to six courses, a few clinic shifts? That does not mean we say we’re proficient in that entire field.
Right now there is a national conversation going on about incorporating multiple disciplines within a field, and around portability of skills and practices between the CAM fields through the National Education Dialogue,and the Academic Consortium for Complementary and Alternative Health Care through the Integrated Health Care Policy Consortium. It is a delicate subject; naturopathic doctors do have the most fingers pointed at them because the naturopathic medicine field integrates practices from the most disciplines. The good news is we ND’s therefore have a great ability after a hundred years of developing curriculum and practice supporting our approach to understand our boundaries. We understand the limits of each of the modalities that we integrate as a whole revolving around our philosophy. This is naturopathic medicine. It is a generalist model using many approaches.
Schleich: The eclecticism of naturopathic medicine is its strength; it also makes it vulnerable. The beauty of the general practitioner of naturopathic medicine is that he or she is willing to embrace new modalities all the time. They fit things into the naturopathic philosophy as needed.
It seems that the Foundations Project in many ways is officially establishing the profession’s foundation and philosophy to contain more effectively the modalities used in the profession. Would you clarify this?
Snider: The philosophy of naturopathic medicine already exists. It was vital and alive in the early part of the 1900s when the field was flourishing. Lindlahr, Lust, and others articulated this philosophy. However, the profession wasn’t unified around its standards at that time as a new field. As the profession went through its decline where we were graduating four doctors a year from NCNM, and Canadian College was just starting in 1978, there was a big gap in the elders coming across that chasm. There were no writings coming out of that time. There were very few writings because people were just barely keeping the profession alive and themselves alive. NCNM was receiving faculty from British Columbia. These veteran NDs were driving down or flying their airplanes down to NCNM to lead, teach, and to keep the profession alive. Scholarship wasn’t really a priority or a possibility. The elders carried pieces of that flame across that dark canyon and taught the few of us that started re-arriving in the field.
I want to be clear that the philosophy does exist. It is already articulated. All we are doing is bringing it forward, making it more rigorous, and refining it. That is deeply important to all of us who are working on this text.
Pamela Snider, ND
Executive and Senior Editor of the Foundations of Naturopathic Medicine Project and former Associate Dean of Naturopathic Medicine and Public and Professional Affairs at Bastyr University. Executive Director of the Academic Consortium for Complementary and Alternative Health Care.
David Schleich, PhD
Former Canadian College of Naturopathic Medicine (CCNM) president and current president and CEO of Truestar Health in Toronto, Canada. Dr. Schleich was former Provost at Niagara College, Canada and the publisher/editor of Quarry Press, Ltd. for many years. His recent book, Total Health and Weight Loss is a best-seller in Canada.