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A fork in the road.

In response to Raymond Khoury's question and Peter Derig's letter (Letter to the Editor. Journal of the Australian Traditional-Medicine Society 2008;14(1):47), I would like to say that I feel the natural medicine professions are at a fork in the road with respect to their future philosophical directions. One direction heads towards biomedicine based on biomedical thinking, diagnosis and biomedical evidence-based practice, while the other direction stays true to holistic natural medicine based on holistic medicine thinking, diagnosis and holistic evidence-based practice. By holistic, I do not mean using everything available at the same time, but seeing the person as a whole being embedded in an interconnected, interrelated and holistic universe.

I feel that our future credibility as healthcare practitioners lies not in cuddling up to biomedicine, but in developing excellence in doing what we do best, that being:

* working within and being true to our holistic paradigms;

* deepening our understanding of the theoretical and applied practices of our holistic medicine systems;

* further developing the comprehensive nature of our natural medicine assessment and diagnostic systems; and,

* continually adapting our practices to an ever changing multicultural world.

I feel that by doing this we will gain greater recognition and further credibility on our terms, not on someone else's.

It is worth remembering that biomedicine is in its infancy as a medical system compared to our traditions and as such, is plagued with the problems of immaturity such as unnecessary surgery (re the recent report re the Alfred Hospital and the horrific Dr Death saga in Queensland), terrible side-effects from many of its medications and a lack of person focus in its application of medicine. Our approaches are safer and more person friendly.

People worldwide are flocking to natural medicine practitioners, not for the same approach as they get from biomedical practitioners, but for something quite different--holistic natural medicine. By its very nature biomedicine is clearly reductionist, while holistic medicine disciplines are not.

It is worth noting that our natural medicine programs usually only provide around 500 to 600 hours of biomedical science education, which could not be regarded as adequate for the purposes of performing biomedical clinical differential diagnosis to determine an organic pathology or practising biomedicine, even if we were allowed to. Biomedical clinical differential diagnosis is a skill that is even difficult to perform accurately after six years of biomedical education. Our diagnostic skills lie elsewhere. They lie in performing a natural medicine assessment and diagnosis (whether that be in accord with the philosophical and theoretical framework of TCM, naturopathy, western herbal medicine, ayurvedic medicine or homoeopathy), which is by its very nature, a whole person or 'systemic' diagnosis, of how the individual is losing or has lost the ability to maintain their own integrity, wellness or dynamic equilibrium.

Why include any biomedical science studies in our holistic natural medicine programs? After all, most of our disciplines have survived for hundreds, if not thousands of years, without them. I think we need to be clear about the purpose of these studies. I suggest that the reason to study biomedicine as part (even though it be a relatively small part) of a holistic natural medicine program is:

* as patients these days are often seeing more than one type of healthcare practitioner, and sometimes communication between a patient's healthcare practitioners is important, and the likelihood of medical practitioners spending the time to learn about our approaches to healthcare are very slim, the onus falls on us, in the interests of our patients, to learn how to communicate with biomedical practitioners. To do that, we need to know where they are coming from. This is also important if we engage in joint management of a patient with a biomedical practitioner. Of course, for the same reasons, we need to be familiar with where each natural medicine discipline is coming from, let alone psychologists, psychiatrists, social workers and the like;

* to monitor of ongoing health issues eg blood pressure; and,

* to recognise life threatening situations where a referral to an emergency facility is needed.

In my opinion, it would be best if biomedicine practitioners focused on offering the best biomedical treatments for those who choose biomedicine, and left natural medicine treatment to the experts (us) and we should do likewise in relation to biomedicine.

As medical practitioners tend not to study the comprehensive nature of holistic natural medicine (quickie courses if that), they cannot do natural medicine as well as we can. And as we really only skim the surface of biomedicine (500 to 600 hours study compared to six years), we cannot do biomedicine as well as medical practitioners.

--Kerry Watson, Melbourne, Victoria

A very interesting letter to the editor appeared in the March 2008 edition of the Journal of the Australian Traditional-Medicine Society, written by Peter Derig (Letter to the Editor. Journal of the Australian Traditional-Medicine Society 2008;14(1):47).

I have nothing but the utmost respect for Peter (my old principal from 1978 to 1993), and Raymond Khoury, editor of this journal, and a friend. I tried very hard not to comment on this because of my respect for these two fellows, but eventually it got the better of me.

I was born with a scientific mind that was always enquiring, seeking evidence for everything, and that has never changed. Linking spirituality to religion and course content in my opinion is totally wrong. Fair enough by all means, examine the effects of people's religion on health, social conduct or whatever else may be applicable, but learning anything to do with religion should not enter a curriculum.

God is a very poor explanation of the world--it is hard to imagine a sane, well-educated person that did not totally believe in evolution because of the overwhelming abundance of evidence. I consider myself spiritual, but I get my spirituality from my love of nature in all its glory.

The second point of discontent for me was Raymond's comments about the adoption of complementary medicine into mainstream medicine. If a medicine or therapy has proven efficacy then it automatically should be moved into mainstream medicine. We have moved into an evidence-based era of medicine, as it should be.

Prove it or remove it should be our motto--it's mine. I did not become a naturopath because I thought it was an alternative to orthodox medicine, I became a naturopath because I believed, and still do, that it offers a lot to health. I always believed that science would prove naturopaths were on the right track. It is inevitable that once a treatment has been proven, it is no longer an alternative, and as such will be moved to orthodox medicine.

Stephen Myers, in his editorial for the Journal of Complementary Medicine May/June 2008, has called for registration of naturopaths/western herbalists as the first part of a solution to the current medical mess. We need to keep going down this path until we achieve registration, and we will do it by embracing what works and discarding useless baggage that doesn't work. This view of mine may not be supported by all complementary medicine practitioners, but I will bet the majority of practitioners support it.

If we remain unregistered, mainstream medicine will keep on integrating the proven therapies until there is nothing left. The researchers that were appointed by the Victorian Government to look at registration for naturopaths/western herbalists identified core therapies belonging to the study of naturopathy--they were herbal medicine, nutrition, counselling, massage and homoeopathy--so finally as practitioners we have an identity. We want to be a part of, not an alternative, to mainstream medicine.

Remember, an alternative to sanity is madness.

--John Bobbin BNat
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Title Annotation:Letters to the Editor
Author:Watson, Kerry; BNat, John Bobbin
Publication:Journal of the Australian Traditional-Medicine Society
Article Type:Letter to the editor
Date:Jun 1, 2008
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