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You be the judge

Jann Bellamy recently recapped her experience attending a meeting sponsored by her local Healing Arts Alliance. As you re-read her article pay particular attention to the language used by the Alliance to describe themselves and the treatments they offer. For me, there is one word that really stands out. It is emblematic of the attitude of the complementary and alternative medicine community. A word meant to represent a virtue is really a self-serving recusal of critical-thinking. Not wanting to misinterpret their intent, I went the website of the Healing Arts Alliance to get the full context. Here is the mission statement, in full, pasted from their website:

The Healing Arts Alliance (HAA) is a network of health care practitioners who offer conventional and complementary or alternative services. We share a commitment to a whole person, patient-centered approach to health and wellness.
Through our respective practices, we seek to support each person in making informed health care and lifestyle choices. We offer information for choosing an effective blend of options to enhance and maintain health and recreate balance from diseased states.
We do not endorse any specific method or system. Our member/practitioners are committed to a nonjudgmental collaboration and co-operative relationship which will bring about the greatest benefit to our clients and patients, our organization, and ourselves.

They hit many of the buzzwords typically associated with the Alt Med vocabulary: whole person…check; patient centered…yup; wellness…yes; balance…of course. But none of those words really riled me like THE word. And what was the word I found so offensive?

non•judg•men•tal
adjective \ˌnän-ˌjəj-ˈmen-təl\

: tending not to judge other people harshly or unfairly : not too critical of other people

: avoiding judgments based on one’s personal and especially moral standards

Such a noble word. Such a virtuous sentiment. Or is it? Perhaps in its common usage, the posture of being nonjudgmental of other people is a virtue. Even that is a debatable opinion, but irrelevant here. The Healing Alliance is using “nonjudgmental” in a different context. They advocate the position of being nonjudgmental toward ideas. The practice of being nonjudgmental about ideas is neither noble nor virtuous. It is misguided and reckless.

Try this. The next time someone asks you for directions to the nearest emergency room, explain that “when it comes to getting from point A to point B I do not endorse any method or system. That would be judgmental.”

All ideas are not equal. It is dangerously naïve to believe otherwise. Acting on ideas has consequences. These consequences may improve, worsen, or be completely irrelevant to the problem we are trying to address. There may be consequences that are unintended and completely unexpected. To deny these facts is to ignore the sum total of human experience. It is to fail to learn from history. It is to be oblivious to the advances in science. It is probably incompatible with survival as an individual or as a species. If we don’t apply some judgement, how are we to distinguish between solutions that are helpful, worthless, or downright dangerous?

Courtesy of Google, more and more patients come to see me with a detailed knowledge of my educational pedigree, my employment history, and my publication record. They don’t do this because they want me to be nonjudgemental about their medical care. The patients I see have problems ranging from trivial to life-changing. The treatment options for each patient are limited only by the collective imaginations of everyone who cares to opine on the subject. Patients want me to use my education, my knowledge, and my experience, to make judgements about their options and help them outline a rational strategy. To assume a nonjudgemental posture would be to abrogate my responsibility to the patient.

So when the members of the Healing Arts Alliance declare a policy of being nonjudgemental, what do they really mean? They seem to want to have it both ways. When it comes to advising patients, their mission statement states:

…we seek to support each person in making informed health care and lifestyle choices. We offer information for choosing an effective blend of options to enhance and maintain health and recreate balance from diseased states.

They advocate offering information and supporting informed choices. I suspect that I would find fault with much if the information offer, but clearly they aim to help people make judgements about healthcare and lifestyle choices. But when it comes to actually implementing these choices and working with each other, they are willing to suspend these very judgements. It’s all for one and one for all:

We do not endorse any specific method or system. Our member/practitioners are committed to a nonjudgmental collaboration and co-operative relationship which will bring about the greatest benefit to our clients and patients, our organization, and ourselves.

There surely must be some limit to this approach. Is there some “method or system” that is too extreme or bizarre for them to accept? Probably, but they appear to be pretty promiscuous in their suspension of judgement. Looking through the membership list I see many chiropractors, several reiki therapists, naturopaths, a doctor of naturology, a Kabbalistic healer, a practitioner of Ayruveda, a shaman, a craniosacral therapist, an astrologer, several acupuncturists, and an M.D. who advocates homeopathy. Looking further into the bios of some of the practitioners I found services including reflexology and most appallingly “Crystal Bed Therapy as used by Brazilian spiritual healer John of God.”

I wonder if conversations like this ever occur between practitioners of the Healing Arts Alliance:

I fear that vibrational frequency of your BioMat therapy and my Frequency Specific Microcurrent are interacting in a way that is unpredictable, and possibly harmful to our patient.

or

It has occurred to me that my acupuncture and your reiki are redundant in their effects on Mr. Smith’s vital force. Since reiki is less invasive, I am going to discontinue acupuncture.

These conversations sound silly, but if the putative effects of these therapies are real and if their practitioners take them seriously, these types of conversations should be taking place. I can assure you that conversations of this sort take place constantly among conscientious professionals collaborating in the care of patients using science-based therapies. They recognize that every treatment that has multiple effects on human physiology that may interact with other treatments, sometimes leading to adverse effects.

If you investigate the philosophies of the various flavors of alternative medicine practiced at the Healing Arts Center, you will learn that many of them are based on constructs of anatomy, physiology, and physics applied to concepts of health and disease that are incompatible with what hundreds of years of scientific inquiry of taught the rest of us. Even more ironically, various forms of alternative medicine are based on constructs of anatomy, physiology, and physics applied to concepts of health and disease that are incompatible with each other.

So how does a collection of practitioners who cannot agree on an alternative version of reality “collaborate and co-operate” in caring for patients? They ignore the conflict. They agree to not disagree. I won’t judge your alternative view of anatomy if you won’t point and laugh at my alternative view of physics.

H. L. Mencken said it quite plainly:

For every complex problem there is an answer that is clear, simple, and wrong.

If I can make a corollary: there may be many clear, simple wrong answers; and a nearly infinite number of obtuse, convoluted and wrong answers.

Fortunately, science and critical thinking have given us tools to assess the likelihood that a hypothesis is true. We have the ability to confirm some and to dismiss others. To ignore these tools under a pretense of being nonjudgmental strikes me as an irresponsible thing for a healthcare professional to do.

Posted in: Science and Medicine

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25 thoughts on “You be the judge

  1. weing says:

    If your job was putting people into gas chambers in concentration camps, and you started having some guilt feelings about your work, wouldn’t you want your doctor to be nonjudgmental and just help you get rid of those feelings so you could get a good nights sleep?

  2. goodnightirene says:

    It seems clear that the average SCAM-follower accepts its myriad manifestations in the same vein that s(he) accepts religion. I’ve had a number of such “friends” who very proudly tell me how they gave up religion, though most claim to remain “spiritual” and now follow one or more types of woo as much or more diligently than they used to follow some religious doctrine.

    They hedge their bets with the notion of “complementary” medicine which allows them to have it both ways. Critical thinking is seen only as criticism that results in “negative energy”, and must be avoided in favor of being “nonjudgmental”–rather like being so open minded that your brains fall out.

    1. windriven says:

      I had a girlfriend once who said she was ‘spiritual’. I asked her what that meant. She tried three or four starts and then realized that she didn’t really know either. To the best of my knowledge she still isn’t religious. But she isn’t ‘spiritual’ either.

      1. Lucas Beauchamp says:

        Run, run, run from anyone claiming to be “spiritual.” The word is devoid of meaning. Windriven’s girlfriend used it how it is mostly used: as a means of stopping any further explication of thought. At one point, I used it that way myself.

        In my legal practice, I have several times come across correspondence discussing something or other as spiritual. I have found that, as a rule of thumb, the more times people use the word, the more self-interested their motive.

        Incidentally, Windriven’s former girlfriend deserves bushels of credit for her willingness to examine her own ideas critically.

  3. windriven says:

    Well I think this is a wonderful turn of events that will usher in a new age of health and prosperity. But we need to move beyond ‘medicine’ and embrace this in the broader society. Think of the huge savings to municipal governments by simply adding a 100C dilution of E. coli to municipal water supplies! We can do away with all those ugly water treatment plants. Capital budgets slashed! Operating budgets slashed!

    What? You don’t think that is a great idea??? Why on earth not?

    1. Frederick says:

      LOL nice one, Cleaning water with water, man Nobel prize for you :-)

    2. DJDenning says:

      Adding E. coli to water makes it organic. Isn’t organic always better?

  4. Tony Burns says:

    Good article. They hit all my alarm words except modality.

  5. Dionigi says:

    and if my particular brand of complementary medicine happens to be scarification, bloodletting, mercury drops, large intake of laudenam or some other alternative form of medicine would they still be non-judgemental?

  6. Badly Shaved Monkey says:

    The numpties of the SCAM world don’t spot the contradictions even when they are explicitly in front of them. Note my emphasis below;

    We do not endorse any specific method or system. Our member/practitioners are committed to a nonjudgmental collaboration and co-operative relationship which will bring about the greatest benefit to our clients and patients, our organization, and ourselves.

    …we seek to support each person in making informed health care and lifestyle choices. We offer information for choosing an effective blend of options to enhance and maintain health and recreate balance from diseased states.

    They say they are “nonjudgmental” but self-evidently regard themselves as equipped to make judgements. The critical feature is the absence of the return leg of their feedback loop. When they think they have found an “effective” therapy that offers “greatest benefit” they will not countenance any criticism of the therapies that, even by their own defective standards are found (judged!) to be ineffective and of least benefit.

    It us not that they don’t make judgements, they patently do. It is that they won’t admit to making judgements for fear of breaking ranks or having judgemental fingers pointed back at themselves. Mr Carey-Sharey, please meet Mr Moral-Coward.

  7. Badly Shaved Monkey says:

    Thank you Autocorrect. But I expect my meaning was clear.

    It is not that they don’t make judgements, they patently do. It is that they won’t admit to making judgements for fear of breaking ranks or having judgemental fingers pointed back at themselves. Mr Carey-Sharey, please meet Mr Moral-Coward.

  8. Chris Hickie says:

    Sounds like this “alliance” is basically a “go along to along” bunch of scammers. ”

    Since none of the snake oil they push would stand up to any true scrutiny, the reason they all get along probably one of false synergy to the patients they fleece. Let’s say I’m interested in reiki, but I’m not sure about homeopathy or chiropractic. Well, I check out this alliance and well, hey, if I think reiki is acceptable, and the reiki-fakeys are allied with all these other (s)CAM groups–well I’m sure some people will make the bad leap of thinking all this woo must be valid and proven. It’s really quite a smart marketing move, but bad news for people tricked down this path.

  9. Susanjt says:

    As always, a well-reasoned, thoughtful article.

  10. Kathy says:

    At present the various woo’s are united because they have an outside enemy, i.e. real medicine. And most of their new patients are coming from there. But if they come into competition with each other for patients, or for the top slots in the Woo’s Woo volume, then the faux comradeship will evaporate like the vague mist it always was.

    There’s no-one so rigidly respectable as an ex-maverick, nor so quick to exclude those they once called their buddies.

    1. Geordie says:

      Well I don’t know what your problem is with this, its Great. I’ve never laughed so much over a document with Gold titles in years.

  11. davdoodles says:

    What a grotesque charade.

    A room full of naked emperors, each furiously agreeing that they are all clothed.
    .

  12. “It has occurred to me that my acupuncture and your reiki are redundant in their effects on Mr. Smith’s vital force. Since reiki is less invasive, I am going to discontinue acupuncture.”

    To a knowledgeable practitioner these two modalities are may not be redundant and can be used together in a treatment regimen. They both are about “energy” but the needle should be used if the tissues are very dense and contracted. In dense and contracted tissues the “light” hands-on therapy of Reiki will not be as effective. In these cases you need an invasive tool and the needles are the safest and most cost effective.

    I’m afraid even in the world of alternative and complementary medicine incomplete theories are abundant.

    As to “judgmental,” it’s the worst disease catalyst in clinical practice. If you take a person who has vertigo and add in confusion, blame, time, insomnia, worry and disrespect, the vertigo will get worse.

    Holistic to me means, non-judgmental, no blaming, assuage worry and the patients gets the utmost respect. ALL of which are missing in modern medicine and a 10 minute non-touching, no eye contact office visit.

    1. WilliamLawrenceUtridge says:

      Oh Stephen, you shouldn’t have come back. You have nothing to add.

      What “energy” is involved? Mechanical? Electrical? Heat? Light? Magnetic? Kinetic? Radioactive? Sonic? Or made-up nonsense “energy” people used as a placeholder because they had no idea how the body actually worked?

      The theories are not incomplete, they are mutually self-contradictory nonsense that bear no relation with the immense amount of knowledge we have about the human body and physics. They are completely compatible with the human ability to fool itself, and the ability for nerves to influence other nerves.

      Holistic to me means, non-judgmental, no blaming, assuage worry and the patients gets the utmost respect. ALL of which are missing in modern medicine and a 10 minute non-touching, no eye contact office visit.

      This statement bears absolutely resemblance to the doctors visits I undertake, except for the fact that my doctor isn’t judgmental, casts no blame and eases my worries, no matter how absurd my concerns end up being. Sounds like you are critical of the structural problems found in the American medical system. And your solution s to clog it up with ineffective nonsense that you charge your presumably wealthy or middle class patients a bundle for. You know what would be a real solution? A real medical system, federally funded, universal, paid by taxes, that values science and quality care. Please, I beg of your nation, join the rest of the world.

      Oh, and abandon all the unscentific nonsense.

      1. Gee, all my time here before did not enlighten anyone on the power of needles?

        Hmmm, explain how the body works in a paragraph!

        I really don’t know that “energy” is , but I do know it is keeping me alive = that energy.

        “A real medical system, federally funded, universal, paid by taxes, that values science and quality care.” This would be a good start!

        Ineffective is relative, it all depends on where you are. I say leave it up to patients how their dollars are allocated.

        1. WilliamLawrenceUtridge says:

          I can explain how the body works in a paragraph. An interlinked series of chemical reactions uses basic substrates to intake energy, oxygen and water, process it into tissues and motion, and expel wastes in the form of gases, urine and feces. Tell me what in there can be fiddled with by inserting needles?

          And you’re allegedly a doctor.

          All your previous time here you merely ignored the scientific research and asserted “it worked for me”. I’ve had acupuncture. It didn’t work for me. Upon testing with good controls, science reveals that acupuncture doesn’t really “work” in a meaningful way, beyond placebo to control pain and nausea. Why does it “work” for you, but not for researchers? I’ll tell you why – because you don’t appreciate the symptomatic nature of the “cures” you charge for.

          Ineffective is relative, it all depends on where you are. I say leave it up to patients how their dollars are allocated.

          And hey, if it means you make a profit off of it, and don’t have to provide any real results, who cares? Who cares if money is wasted and patients aren’t actually helped, as long as you get to pocket some cash and pat yourself on the back for being such a good doctor. You credulous fool.

    2. David Weinberg says:

      Stephen,

      You are defending your own definition of “judgement” and “nonjudgemental.” Your definition is clearly different than the definition I challenged in the article. Do you have any opinion about that?

      1. Hmmm … my definition was clear to you … lol, I was not even sure what my definition was.

        Judgement has to do with some factual elements. judgmental has to do with opinions and belief. What do you think?

        This site is about mostly individual opinion. IMO … lol

        1. David Weinberg says:

          Stephen asks : “What do you think?

          Odd you should ask. I devoted several hours and pounded out 1300 words explaining what I think. Was I not clear?

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