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Letters to the editor.

To the Editor,

Naturopathy has no default pre-determined opinion on vaccination

I read with interest the recent editorial on vaccination. This is indeed a debate the profession needs to have, but I fear that the emotion that often surrounds this sensitive issue may impact the ability to have a constructive and respectful discussion. I have already seen and heard in various circles outrage by some practitioners that supporting vaccination is somehow 'anti-naturopathic'. However, not only is this untrue, it is also offensive in a profession that prides itself on the autonomy and individualised approach afforded to practitioners. In the inevitable controversy that will surround, but hopefully not consume, this discussion, I would urge participants to understand that there is no 'true' comprehensive and infallible naturopathic opinion on this topic, and to participate in this conversation in an open and respectful manner.

Some practitioners, for example, may falsely believe that vaccination is incongruent with naturopathic principles and philosophy. However, vaccinations are low dose, preventive and work by gently encouraging the body's own innate immune response to act rather than pharmacologically overwhelming a condition with medication. By this definition they could very well be defined as a naturopathic treatment that aligns completely with naturopathic principles and philosophy. The argument that "the principle of vaccination, according to the naturopathic principle of unity of disease, evades the primary factors responsible, which are usually environmental and nutritional" (1) is irrelevant to contemporary naturopathic practice, or at least it is if practitioners wish to continue to use or refer to other 'evasive' treatments such as homeopathy, herbal medicine, physical therapies or acupuncture. It should be remembered that the use of ingestive therapies, now commonplace in modern naturopathic practice, were once considered equally offensive to the traditional nature cure adherents that began the naturopathic profession. Lindlahr also posited that naturopaths opposed vaccination because "naturopathy holds that germs, bacteria and parasites are products of disease rather than its cause" arguing that "germs of themselves cannot create disease--if they could, humanity would soon be extinct" (2) Whilst certainly supporting the argument that vaccinations should not be perceived as a panacea by modern naturopaths (they are not), this statement is clearly no longer relevant to modern naturopaths who do accept germ theory, though also appreciate the importance of supporting other factors that support health.

Nor is vaccination incongruent with the naturopathic profession. In fact early Australian naturopaths were not always against vaccination as a principle, but were more opposed to the medical community's monopoly on vaccination. Some even tried to claim credit for it--with one early naturopathic journal stating that "[a]lthough vaccination is indissolubly linked with the name of Jenner, there is ample evidence that it was practiced by farmers and others in the rural districts of England well before his day. It was common knowledge amongst folk healers". (3) When opposition did exist, it was primarily focused on smallpox vaccination, which in the early 19th century was both crude with a relative high risk of infection (though, as history shows, was also undoubtedly effective). (4) However, transferring opposition to these previous vaccines to the significantly different modern vaccines, or opposing vaccination as a homogenous entity rather than assessing vaccines individually, is analogous to opposing all herbal medicines because Withering's original recommendations of Digitalis extract in dropsy were so unpredictably risky (though also undoubtedly effective, so much so that standardised alternatives are still used in conventional medicine). (5)

Informed public debate about the pros and cons of vaccination is an unqualified public good. (6) It is also a personal choice. Many naturopaths would class themselves as 'pro-choice' in relation to their views on vaccination. Such a view necessitates that both cases, supporting and not supporting vaccination, be presented as potential choices. Those practitioners who are uncomfortable with this reality need to reassess their use of this term, and ethically need to more accurately refer to their pro- or anti- positions, rather than obfuscate their true opinion behind a more palatable term. Some individuals may choose, based on their own interpretation of the risks and benefits, to avoid or advise against vaccination. This may be a valid choice for them to make, but it is not 'the only' naturopathic choice. Vaccination can align with naturopathic principles just as much as vaccine skepticism can, and supporting vaccination makes one no less of a practitioner than not supporting it. This is a debate the profession needs to have, but it needs to be respectful, and we need to acknowledge that having different viewpoints within a profession is okay.

Dr Jon Wardle

Faculty of Health, University of Technology Sydney

Building 10, Jones Street, Ultimo, NSW, Australia

(1.) Turner RN. 1990. Naturopathic Medicine: Treating the Whole Person. Wellingborough: Thorsons

(2.) Lindlahr H. 1910. The anti-vaccination crusade. Herald of Health and Naturopath 15(3):129-131.

(3.) Story, TG The First Vaccinators. Harbinger of Health 2(7):14

(4.) Special Commission (1900). "Report of the Lancet Special Commission on Glycerinated Calf Lymph Vaccines" Lancet 155 (4000):1227-1223.

(5.) Withering, W (1785). An Account of the Foxglove and some of its Medical Uses With Practical Remarks on Dropsy and Other Diseases London: GJ and J Robinson

(6.) Wardle J, Stewart C, Parker M (2014) "Jabs and barbs: ways to address misleading vaccination and immunisation information using currently available strategies." Journal of Law and Medicine 21(1):159-170.

To the Editor,

I wish to extend my congratulations for a well-written and interesting perspective in your editorial piece last issue (27:3) regarding attitudes towards vaccination within the profession.

It concerns me that a number of naturopaths and herbalists align themselves with the view that anti-vaccination is a fundamental naturopathic belief/ principle or conversely, that vaccination goes against naturopathic principles. Furthermore, and of greater concern, I have seen this sentiment in some students and early graduates, who perhaps have not been educated otherwise. Quite simply, an anti-vaccination stance is not a naturopathic principle. On the contrary, one could argue that vaccination indeed aligns with three of the six fundamental naturopathic principles:

* Primere non nocere

* Docere

* Preventir

Intended to lower the risk of serious infectious disease in the community, the introduction of vaccines has led to a significant reduction in many preventable diseases. Undoubtedly, there is a risk of side effects with vaccinations, as there is with all interventions. The risks, particularly when managed effectively, are outweighed by the benefits of modern vaccines; aligning with the naturopathic principles of "first do not harm" and preventative healthcare. Ongoing research, monitoring, and surveillance of the effect and safety of vaccines ensure knowledge and understanding of these medications is current, relevant and accurate.

As complementary health care practitioners we have the potential to play an important role in the education of patients' understanding of vaccines, in line with the principle of teacher. We are responsible for the advice and guidance that we provide and this should be based on facts and current best practice rather than opinion.

Some excellent resources available online to learn more about immunisation and the current vaccination schedule include the Melbourne Vaccine Education Centre www. mvec..vic.edu.au and the Australian Academy of Science https://www.science.org.au/immunisation

Jodie Tester

University of New South Wales

Sydney NSW 2052

To the Editor,

Thank you for such a great editorial in the latest AJHM that points out the importance of education in vaccination. I'm a qualified naturopath from Southern School of Natural Therapies (SSNT) and also a clinical nurse specialist and qualified immunisation nurse. I agree that this whole debate on whether to vaccinate or not has gained so much craziness and momentum in the last few years.

Unfortunately, whilst doing my immunisation certificate at Latrobe University, I witnessed many nurse immunisers bad mouthing naturopaths, assuming they all have anti-vaccination attitudes, when this isn't at all true. There are however some naturopaths and other complementary practitioners who focus only on the risks (often uneducated immunisation based opinions) of vaccination rather than the benefits. While obviously all naturopaths can't and probably don't want to become a nurse immuniser I strongly agree with you that there is a lack of correct information/education sought by naturopaths on this topic and it is time we talked about immunisation. I have recently had the pleasure of starting work at SSNT as a teaching assistant in the naturopathic clinic and do my best to correctly inform students when asked about immunisation from both my experience and my education. This really can be an area for an integrative approach and I think that all naturopaths/ herbalists etc. would benefit from reading your editorial as much as I have. I am about to commence a Masters in Public Heath at Melbourne University through the global health stream and look forward to learning more about this topic and being able to provide an integrated opinion that continues to support both naturopathic and main stream medicine practices.

Natasha Culver

Integrated Naturopathic Medicine

19A Boyd St Altona, Victoria, Australia

natasha@naturopathiclifestyle.com.au

The Editorial in the last edition--Aust J Herb Med 27(2)--sparked a few thought-provoking letters to the Editor. All letters positively re-enforced the editorial's main message that there is an education need for naturopaths and herbalists in relation to the risks and benefits of vaccination. It was also interesting to me that all of the letters detail how vaccinations align with naturopathic principles and practice. All letters to the Editor received on this topic were published.

Dr Jane Frawley

Editor, Australian Journal Herbal Medicine

editorajhm@nhaa.org.au
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Title Annotation:To the Editor
Author:Wardle, Jon; Tester, Jodie; Culver, Natasha
Publication:Australian Journal of Herbal Medicine
Article Type:Letter to the editor
Date:Sep 1, 2015
Words:1584
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