Articles

“CAL”: a Medico-Legal Parable

Preamble

From the fall of 2000 to the winter of 2002, the Commonwealth of Massachusetts convened a Special Commission on Complementary and Alternative Medical Practitioners. There were 12 members: 6 legislators, 3 MDs, a naturopath, a lawyer who represented the New England School of Acupuncture, and the chairman, who was also the Director of the Massachusetts Division of Professional Licensure. At the start of deliberations two things became apparent: first, the Commission would concern itself almost exclusively with the petition of “naturopathic physicians” to become licensed health care practitioners in the Commonwealth*; second, there were only two recognizable, medically-sophisticated skeptics among the members. They were Arnold “Bud” Relman, the emeritus editor of the New England Journal of Medicine (appointed by the Massachusetts Board of Registration in Medicine), and I (appointed by the Mass. Medical Society). We expected a third, an MD soon to be appointed by the Commissioner of Public Health, Dr. Howard Koh.

Within a few weeks it became clear that the third MD would not be a skeptic. Dr. Koh, apparently thinking he had found an expert, appointed as his representative David Eisenberg, Director of the Harvard Medical School (HMS) Division for Research and Education in Complementary and Integrative Medical Therapies. Dr. Koh must not have known that in 1997 Dr. Eisenberg had called for

A national listing of licensed alternative medical providers (e.g., chiropractors, acupuncturists, massage therapists, naturopaths, and homeopaths) in each of the 50 states as well as a uniform credentialing process.

Commissioner Koh also must not have known that Dr. Eisenberg had received or was currently receiving funds from several sources committed to furthering the ambitions of ”CAM” practitioners in general or of “naturopathic physicians” in particular: the NCCAM, the Fetzer Institute, the New York Chiropractic College, Cambridge Muscular Therapy Institute, New England School of Acupuncture, American Specialty Health Plan, and the Southwest College of Naturopathic Medicine.

Dr. Eisenberg directed an annual conference that was funded by several of those institutions and that offered continuing education credits for acupuncturists, chiropractors, “massage therapists and bodyworkers,” and “naturopathic physicians.” He and his right-hand man Ted Kaptchuk had shown a substantial interest in the selling of “CAM,” not merely in its “Research and Education,” and in 1999 they had joined naturopaths from Bastyr, National College of Naturopathic Medicine, and University of Bridgeport College of Naturopathic Medicine at a conference on “Complementary and Alternative Medicine in Chronic Liver Disease,” co-sponsored by the NIH and the American Association of Naturopathic Physicians.

After Dr. Eisenberg’s appointment, it became clear that he would not be coming to most of the meetings. Instead he sent his “Director of Legal Programs,” attorney Michael Cohen. Mr. Cohen was also committed to the goals of naturopaths and other “CAM” practitioners, and at the time was on the Advisory Board of the American Association for Health Freedom—a lobbying organization of quacks. Neither Dr. Eisenberg nor Mr. Cohen disclosed their associations to members of the Commission or, I presume, to Dr. Koh. Dr. Relman and I were yet too green and too busy with other matters to discover them ourselves. When I finally began to dig, I reported several of my findings to Dr. Daniel Federman, the Dean of Alumni at HMS, whom I had formerly respected and trusted. That is a long, disappointing story, partially told here and here. Suffice it to say that it does not provide an exception to the rule that everyone has his price.

What Dr. Relman and I did recognize during the early deliberations of the Special Commission is that we were fighting an uphill battle for rational medicine. We also found that we would not be getting any help from Eisenberg, whom the other members presumed to be the expert on the topic. As we delved into naturopathic practices and claims, it was obvious to us that they were absurd and dangerous (see here and here for examples that we presented to the Commission), but our points were met with blank stares or worse.

During one meeting I attempted to get the Commission’s attention by citing a naturopathic recommendation for treating an acute asthma attack by placing the patient in a bath containing “a cup or so of 3% hydrogen peroxide in the water to bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry.” Shortly thereafter, the chairman of the Commission, William Wood, pronounced that the differences of opinion between MDs and naturopaths amounted to nothing more than a “battle of the bands.”

That and similar experiences led me to try “alternative” arguments that I hoped might jar commission members to understand what had failed to impress them when presented in a direct way. If I could argue from legal concepts instead of from biological or medical ones, perhaps the several lawyers in the room would finally get it. Perhaps, for example, I could make them realize that naturopathic claims had the same validity for health and disease as “spectral evidence” had for jurisprudence. This seemed especially appealing to me, given the irony of our deliberating not far from the hallowed ground upon which Massachusetts Royal Governor William Phips had put a stop to the Salem Witch Trials a little more than 300 years before.

It didn’t work; I was met with more blank stares. To this day I don’t know whether the lawyers and legislators in the room knew little of an important chapter in the histories of their own profession and Commonwealth, or whether they understood exactly what I was saying but ignored it because the fix had been in from the start. Nevertheless, I later decided that it might be fun to turn the story of my experiences on the Special Commission and in investigating “naturopathic medicine” into a parable, similar to Steve Novella’s “Alternative Engineering” on Quackwatch. I wrote most of it a few years ago; it didn’t seem that good, and I forgot about it until Mark Crislip posted his “Alternative Flight” here on SBM in January. I hauled it out of the mothballs of my hard drive; it still isn’t that good, but what the heck? I decided that it would be useful for a week when I had little time or inclination to do the real digging, and I’ve been on vacation for a week, so here it is.

“CAL”: a Medico-Legal Parable

The Natural Law School (NatchL) was recently created. Its founders and professors state that it teaches the same basic subjects as “conventional” law schools, but also offers a curriculum that is complementary to stodgy old Conventional Law (ConLaw). It integrates modern legal theory with vis litigatrix naturae, “the legal power of nature.”[1] This refers to the body politic’s innate power to heal its own disputes. Natural Lawyers “treat the underlying causes of conflict, rather than merely eliminate or suppress social and interpersonal altercations.”[2] The school draws from the traditions of many indigenous legal systems around the world, because it recognizes that Western Law doesn’t have a monopoly on truth. Its students, the professors tell us, are taught the same rules of evidence that ConLaw students learn, and can pass an NLBEX (natural law bar exam) to prove it.[3,4] According to the NatchL website, its graduates’ “scope of practice includes all aspects of family law, and all natural legal modalities.”[5]

The school asserts that it teaches natural, gentle legal remedies, instead of the more arduous ones that are so prevalent in Conventional Law.[2] Conventional Lawyers haven’t bothered to read NatchL literature, so they aren’t sure what those gentle legal remedies might be. They know a little about alternative approaches to resolving disputes, however, and thus assume that NatchL must stress arbitration and mediation instead of litigation. Many Conventional Lawyers are impressed that the President of NatchL has been invited to serve on a White House Commission that will consider the new Complementary and Alternative Law (CAL), which, by all accounts, is sweeping the land.[6] NatchL faculty and graduates want to know why Natural Lawyers shouldn’t be admitted to the bar, eligible to become judges, and entitled to all the other privileges pursuant to Conventional legal training.

The State Bar Association appoints a Conventional Lawyer to a State Commission that will consider the petition of NatchL grads to be admitted to the bar.[7] Natural Lawyers have already been admitted in a few states, and several legislators and a few constituents feel that it is a no-brainer to admit them here, especially when there are other people offering natural legal advice and calling themselves Natural Lawyers, but who didn’t graduate from NatchL. Shouldn’t the public be protected from impostors?

The Conventional Lawyer takes his charge seriously and looks into the field of Natural Law in some detail. To his great surprise he discovers, by reading the Textbook of Natural Law,[8] the NatchL course catalog,[9] and other Natural Law literature widely available in the public domain, that while NatchL students take courses nominally pertaining to “conventional” rules of evidence, they are also taught that many “alternative” rules are equally valid. Among the latter are Spectral Evidence, Psychic Testimony, Intuitive Evidence, Past Lives Evidence, Alien Abduction Evidence, Recovered Memory Evidence, and Polygraphs.[10-15] Natural Law School even offers a course in Comparative Heart Weighing, which its catalog describes as

…the most comprehensive and one of the world’s oldest systems of jurisprudence. It encompasses physical, mental and spiritual aspects of human justice and is introduced in the light of its twentieth century revolutionary reformation and resynthesis, with brief history of its competitive existence, stature and staying power.[16]

The Conventional Lawyer finds numerous other departures from modern legal theory and practice, many that were discredited generations ago and others that are contrary to basic legal principles. One of them, Star Chamber Justice,[17] is said by NatchL faculty to have been suppressed in the 17th century “when Conventional Law first began to achieve hegemony as the dominant Western legal system,” but now has been rediscovered, and “even many Conventional Lawyers admit that its adjudications are not completely due to caprice.”[18] Another, the Rack and Screw, has been out of favor in the West for many years but has achieved a large following and a reputation for effectiveness in parts of the Middle East.

The Conventional Lawyer finds that there doesn’t seem to be an effort by the leaders of Natural Law to curb these practices; on the contrary, the leaders themselves advocate them. They are even formalized in the Position Papers of the American Association of Natural Lawyers (AANL).[19] Moreover, he finds no evidence that admission of Natural Lawyers to the bar in other states has protected the public, because all of these practices and more—including some not even taught at NatchL —are promulgated in continuing legal education courses listed by the few state Natural Law Bar Associations.[20]

The Conventional Lawyer concludes that he can’t support the petition of Natural Lawyers to be admitted to the bar, and writes the Commission’s report to the state legislature explaining why.[21] Oddly, this turns out to be the Commission’s “minority” report. The majority feels that the tenets of Natural Law are irrelevant to the Commission’s deliberations, because what really matter are schools, accreditations, standardized exams, a national organization, and other trappings of legitimacy.[22] After all, Natural Law is an “emerging profession” and therefore can’t be expected to have accumulated as many court opinions or law review articles as has Conventional Law.[23,24] Moreover, as the Chairman of the Commission himself observes, the differences between Natural and Conventional Law amount merely to a “battle of the bands,” with neither side having more claim to truth than the other.[25]

The Conventional Lawyer subsequently writes an article for the online LawScape General Law Review (GenLawRev) describing some of his findings.[26] He doesn’t discuss Conventional Law because that isn’t the article’s purpose. The article is read by Natural Lawyers, including the leaders of NatchL and AANL. They write letters to the editor of GenLawRev complaining that Natural Lawyers don’t actually do any of the things that the author has asserted, but that those practices are nevertheless supported by thousands of law review articles.[27-31]

Those correspondents and others, including some ConLawyers, write that the Conventional Lawyer who wrote the article shouldn’t talk, because look at how bad Conventional Law is. They say that it’s obvious from ConLaw’s failure to convict O.J. that CAL must have a lot to offer. Some write that the thousands of wrongfully convicted prisoners in the Conventional criminal justice system prove Natural Law’s validity. Apparently (they don’t actually say) these writers believe that if Spectral Evidence or Psychic Testimony had been admissible at those trials, justice would have prevailed.

A couple of Conventional Lawyers write particularly angry letters decrying the author’s statements and conclusions.[32,33] They say that he must be “flagrantly biased,” presumably because he used examples such as Past Lives Evidence, but they don’t say which of his statements are inaccurate. These two Conventional Lawyers haven’t investigated Natural Law literature themselves. They just know that the author is wrong because they are acquainted with a few Natural Lawyers and find them to be very nice people. One of the Conventional Lawyers suggests that the short time she has to spend with clients must mean that Natural Lawyers have something important to teach Conventional Lawyers, and she is ashamed that she did not learn this in law school.[32] The other Conventional Lawyer, who is the recipient of $1 million in public funds earmarked for sympathetic studies of CAL, cites Shakespeare to show the author the error of his ways.[33]

The author responds to these letters, imagining that some readers might be persuaded by reason.[34]

1. Inspired by: Bastyr University website. Information about Naturopathic Medicine. Accessed 1/04 at: http://www.bastyr.edu/academic/naturopath/

2. Inspired by: American Association of Naturopathic Physicians. Principles. Accessed 1/04 at: http://web.archive.org/web/20030818114817/http://www.naturopathic.org/about/principles_.html

3. Inspired by: Naturopathic physicians are rigorously trained. Association of Accredited Naturopathic Medical Colleges website. Accessed 2/08 at: http://www.aanmc.org/nat_med/trained.php

4. Inspired by: North American Board of Naturopathic Examiners website. Accessed 2/08 at: http://www.nabne.org/

5. Inspired by: Bastyr University website. Information about Naturopathic Medicine. Accessed 1/04 at: http://www.bastyr.edu/academic/naturopath/

6. Inspired by: White House Commission on Complementary and Alternative Medicine Policy. Commission Members. Joseph E. Pizzorno, Jr., N.D. Accessed 3/07 at: http://govinfo.library.unt.edu/whccamp/members/jep.html

7. Inspired by: Reports of the Special Commission on Complementary and Alternative Medical Practitioners. Commonwealth of Massachusetts. Division of Professional Licensure. Website. Last modified 12/11/02. Available at: http://web.archive.org/web/20030220062958/http://www.state.ma.us/reg/current/2002medp/

8. Inspired by: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 2nd ed. London, England: Churchill Livingstone; 1999.

9. Inspired by: Bastyr University Course Catalog. 2001. Accessed 3/08 at: http://web.archive.org/web/20010430174446/bastyr.edu/catalog/courses/

10. Wikipedia contributors. Spectral evidence. Wikipedia, The Free Encyclopedia. February 3, 2008, 22:19 UTC. Available at: http://en.wikipedia.org/w/index.php?title=Spectral_evidence&oldid=188896279 . Accessed February 29, 2008.

11. Rowe WF. Psychic Detectives: A Critical Examination. Skeptical Inquirer. 1993;17(2):159-165

12. Bloomberg D. Can an Idiot Be Psychic? Book review of The Complete Idiot’s Guide to Being Psychic By Lynne Robinson and LaVonne Carlson-Finnerty Alpha Books, New York. 1999. ISBN 0-02-862904-3. Skeptical Inquirer Sept/Oct 1999. Available at: http://www.csicop.org/si/9909/book-review.html Accessed 1/04.

13. Blackmore S. Abduction by Aliens or Sleep Paralysis? Skeptic Inquirer May/June 1998. Available at: http://www.csicop.org/si/9805/abduction.html Accessed 1/04.

14. Canadian Psychological Association. Guidelines for Psychologists Addressing Recovered Memories. Approved by CPA, 1996 (updated 2001). Available at: http://web.archive.org/web/20050516202732/http://www.cpa.ca/recmem.pdf

15. Zelicoff AP. Polygraphs and the National Labs: Dangerous Ruse Undermines National Security. Skeptical Inquirer July/August 2001. Available at: http://www.csicop.org/si/2001-07/polygraph.html Accessed 1/04.

16. Inspired by: Bastyr University Catalog 2003-2004. NM9541 Yunani System of Health and Healing. (p.104). Accessed 1/04 at: http://www.bastyr.edu/ftp/Catalog03-04.pdf

17. Wikipedia contributors. Star Chamber. Wikipedia, The Free Encyclopedia. February 29, 2008, 01:45 UTC. Available at: http://en.wikipedia.org/w/index.php?title=Star_Chamber&oldid=194802041 Accessed February 29, 2008.

18. Inspired by: Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997 Sep 20;350(9081):834-43. Abstract available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9310601&dopt=Abstract

19. Inspired by: American Association of Naturopathic Physicians. Position Papers. Available at: http://web.archive.org/web/20031202204818/http://www.naturopathic.org/positions/positions_and_practice.html Accessed 5/08.

20. Inspired by: Oregon Board of Naturopathic Examiners. Continuing Education. Accessed 1/04 at: http://web.archive.org/web/20040213222559/http://www.obne.state.or.us/conted.htm

21. Inspired by: Atwood KC, Ryder WJ. Minority Report of the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, In Opposition to the Licensure of Naturopaths. Reported to the state legislature January 2002. Available at: http://www.quackwatch.com/01QuackeryRelatedTopics/Naturopathy/minority.pdf Accessed December 2003.

22. Inspired by: Multiple authors. Majority Report of the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, favoring the licensure of naturopaths. Reported to the state legislature January 2002. Available at: http://www.quackwatch.com/01QuackeryRelatedTopics/Naturopathy/majority.pdf

23. Inspired by: Hough HJ, Dower C, O’Neil EH. Profile of a Profession: Naturopathic Practice. The Center for the Health Professions, University of California, San Francisco. 2001. P. IX. Accessed 3/08 at: http://www.futurehealth.ucsf.edu/pdf_files/Naturo2.pdf

24. Inspired by: Testimony offered by Barbara Silbert, President of the Massachusetts Association of Naturopathic Physicians, at the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners (2000-2002), to explain the paucity of rigorous, peer-reviewed literature supporting naturopathic methods.

25. Inspired by: Personal communication with Bill Wood, Chairman of the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners and Director of the Massachusetts Division of Professional Licensure, regarding naturopathic claims vs. critiques based on human biology and modern medicine. June 2001.

26. Inspired by: Atwood KC. Naturopathy: a critical appraisal. Medscape General Medicine 5(4), 2003. Available at: http://www.medscape.com/viewarticle/465994 Accessed 1/04

27. Inspired by: Zeitlin KF. We are all doctors. Letter. MedGenMed. Posted 03/24/2004. Available at: http://www.medscape.com/viewarticle/470692

28. Inspired by: Boggs ND, Mittman P. Naturopathic medicine is an emerging field in one of medicine’s most dynamic eras. Letter. MedGenMed. Available at: http://www.medscape.com/viewarticle/470702

29. Inspired by: Gagnier JJ. Interventions employed by accredited naturopathic medical schools and their practitioners prove efficacious. Letter. MedGenMed. Posted 03/24/2004. Available at: http://www.medscape.com/viewarticle/470711

30. Inspired by: Shepherd TC. Professional agendas and mechanisms for standardized licensure exams do exist in teaching naturopathic medicine. Letter. MedGenMed. Posted 03/24/2004. Available at: http://www.medscape.com/viewarticle/470700

31. Inspired by: Bongiorno PB, LoGiudice P. Naturopathic medicine is indeed legitimate, effective, and wanted. Letter. MedGenMed. Posted 03/24/2004. Available at: http://www.medscape.com/viewarticle/470701

32. Inspired by: Jacobson J. Working toward more patient-centered integrative care. Letter. MedGenMed. Posted 03/24/2004. Available at: http://www.medscape.com/viewarticle/470709

33. Inspired by: Katz DL. Acting in defense of the medical literature. Letter. MedGenMed. Posted 03/24/2004. Available at: http://www.medscape.com/viewarticle/470713

34. Inspired by: Atwood KC. Naturopathy, Pseudoscience, and Medicine: myths and fallacies vs. truth. MedGenMed 6(1), 2004. Available at: http://www.medscape.com/viewarticle/471156

………

*The Naturopathy Series:

  1. “CAL”: a Medico-Legal Parable
  2. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 1
  3. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2
  4. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3
  5. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 4
  6. Colorado is Nearer to Promoting Naturopathic Pseudomedicine—Aided by the Colorado Medical Society
  7. Naturopathy and Liberal Politics: Strange Bedfellows
  8. Open Letter to Dr. Josephine Briggs
  9. Smallpox and Pseudomedicine

 

Posted in: Politics and Regulation, Science and Medicine

Leave a Comment (10) ↓

10 thoughts on ““CAL”: a Medico-Legal Parable

  1. Joe says:

    My late father, a lawyer, would have enjoyed your parody; as I did.

    Kimball, I appreciate your work (and Dr. Relman’s) on that panel. I never understood why your “minority opinion” held sway; but I am glad it did.

    As for the ND suggesting absorbing oxygen (as peroxide) through skin- apparently she does not know that the technical term for people trying to absorb oxygen through their skin is “drowning;” the difference between oxygen and peroxide not withstanding.

    If I recall: you counted ca. 36 would-be licensed NDs in the state in 2002. I live in the most rural area in MA, and I am chagrined to note that there are two (count them- 2) within walking-distance of my place. Why am I so … blessed?

  2. bcorden says:

    Please, no false humility. This is an excellent parody. I suspect that John Yoo is a stealth member of some CAL faculty. Can we blame the perversion of science (Intelligent Design), Medicine (CAM) and Law (CAL) on some strange, collective hysteria? Must be something in the water we’re drinking.

  3. DLC says:

    Good article.
    I am reminded of a Youtube video someone had on their blog earlier this year. Something about Al-Med-ER, a parody of the popular NBC TV show using alternative medicine instead of “conventional” medicine. a laugh riot, and well-deserved finger in the eye of alties.

  4. Sastra says:

    Hilarious — and brilliant parody.

  5. wertys says:

    You know I bet that sCAMmers would argue that this was a blatant misrepresentation of their situation and highly representative of the closed-mindedness of Those Who Would Suppress Natural Medicine. Most amusing.

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