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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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