On July 14, 2021, the FBI arrested Juli Mazi, a licensed California naturopathic doctor, charging her with one count each of wire fraud and “making false statements related to health care matters”. The Justice Department press release described it as “[T]he first federal criminal fraud prosecution related to homeoprophylaxis immunizations and fraudulent Centers for Disease Control and Prevention (CDC) COVID-19 vaccination record cards.”
Every naturopathic doctor and naturopathic medical organization that I am aware of is understandably and justifiably shocked, saddened and horrified. Mazi endangered her patients and the public health, breached professional ethics, and violated the law. What she did was certainly not in line with the clinical science and ethics taught at the naturopathic medical schools. Homeoprophylaxis does not work [1] and (to my knowledge) it is not taught in the accredited naturopathic medical schools. And like all healthcare professionals, we are ethically and legally obligated to keep accurate, unaltered (and un-fabricated) records.
The naturopathic doctor who was arrested is responsible for her own actions, and the choices she made are hers alone. And yet, in my opinion, the national US naturopathic organizations [2] and institutions need to reflect on where and how they have contributed to this situation. The American Association of Naturopathic Physicians (AANP) issued a statement that “Putting the health of patients and others at risk by fraudulently presenting any treatment as a replacement for authorized vaccines, and falsifying documents is both illegal and unethical.” Yet while representing themselves publicly as pro-vaccination, the AANP and the continuing medical accreditation organization (NANCEAC) have continued to provide a conduit for anti-vaccination views and practices. This includes promoting homeopathy as a substitute for science-based, evidence-proven, authorized vaccinations.
There are definitely naturopathic medical organizations that embrace the conventional medical and scientific consensus on vaccination, such as NDs For Vaccines and the Naturopathic Academy of Primary Care Physicians. However the United States national naturopathic association, the American Association of Naturopathic Physicians, and the naturopathic regulatory bodies have been more ambivalent. This appears to be largely due to the presence of a vocal and active minority in the profession who hold stringently anti-vaccine views, and who still appear to influence the profession out of proportion to their numbers.
Thus despite pro-vaccination NDs proposing position papers that strongly support vaccination, the AANP is still without a position paper on vaccination, some years after an earlier version was allowed to lapse. And it’s not uncommon for a pro-vaccination gesture on the part of the AANP – such as allowing a pro-vaccination talk to be given at a national convention – to be followed by an anti-vaccination counter-move.
Consider the following. In late March 2021 the AANP (American Association of Naturopathic Physicians) put out a statement making the case for naturopathic doctors to be allowed to give COVID-19 vaccines. The press release also argued for allowing NDs to help educate vaccine-hesitant individuals. A week later the AANP sent out a weekly newsletter to their members [3], featuring a July 2020 Townsend Newsletter article on homeoprophylaxis by Thomas Kruzel, ND. Kruzel’s article, while not referencing COVID-19 directly, argued for the use of homeoprophylaxis (using homeopathy to prevent communicable disease) and against vaccination – including in epidemics. This pro-homeoprophylaxis article was for AANP members to distribute to the public via social media, on websites and blogs, and as patient material. This, in the middle of a pandemic.
There are many pro-vaccine NDs who give authorized vaccinations and educate according to the scientific evidence; but the material the AANP provided for “patient education” was anything but pro-vaccination.
I have written before about pro-homeoprophylaxis courses offered during or after the AANPs’ national convention. One session in 2019 featured a speaker focusing on using homeopathic remedies during a pandemic. Another featured the Naturopathic Medicine Institute (NMI), an anti-vaccination naturopathic group, presenting therapies that they claimed could replace vaccination for such diseases as measles.
Or take FNMRA/NANCEAC, the North American Naturopathic Continuing Education Accreditation Council. They credential providers of continuing medical education for licensed naturopathic doctors. Out of their five (!) accredited CME providers one is NMI, mentioned above, which opposes vaccination and promotes homeoprophylaxis. Another is the Homeopathic Association of Naturopathic Physicians (HANP); one board member is also connected to NMI. A third is Medicine Talk, founded by (again) an NMI board member. These three groups are given the same accreditation as another NANCEAC provider who offers critical reviews of the literature according to Cochrane guidelines and an organization focusing on gastrointestinal ailments.
This both-side-ism perpetuates a profession where members frequently hold contradictory and mutually exclusive views regarding fundamental aspects of health and illness. I am not saying that all members of a profession should think in lockstep. There will always be diversity. But there needs to be at least some consensus in core areas, such as what the nature of the problem is, and the overall approach to determining how to address it. The naturopathic profession contains at least two camps with sharply opposing views regarding a core aspect of medicine: dealing with infectious disease.
Division is not new to the naturopathic profession; division in naturopathy has probably been inherent since its founder, Benedict Lust, decided to try to bring the varied branches of early-twentieth-century American alternative medicine under the umbrella of “therapeutic universalism“. At that time, however, the divisions were those between various branches of alternative therapies, each claiming that it alone had a singular grasp on the causes of illness in humanity. Today, the naturopathic medical profession is divided between those who use science to evaluate naturopathic medicine’s principles and practices, and those who use the principles of naturopathic philosophy to evaluate science.
Both types of attitudes can be found in NDs in the current profession, especially with regard to homeopathy and the prevention and treatment of infectious illness. The divisions about vaccination are connected to sharp disagreement about what causes infectious illness and at times whether infectious illness is even a concern or not. Modern naturopathic medicine, and the vast majority of NDs that I am aware of, embraces and accept the germ theory of infectious illness. This is what is taught in the schools, and I can state that neither as a student nor an instructor did I hear it once questioned at Bastyr. However, prior to its revival in the late 1970s, naturopathy rejected the germ theory of infectious illness. Outside of formal instruction, naturopathic students and practitioners still encounter groups, courses, and mentors who do indeed dispute the germ theory of infectious illness to varying degrees, and the place of the scientific method itself. This “informal curriculum” shapes first students‘ [4] and then practitioners’ beliefs and practice in ways that are at odds with both the formal curriculum and the public image of the profession.
(This informal curriculum’s existence also explains why different naturopathic doctors can hold contradictory views on core aspects of medicine. Depending on which social networks a student and then practitioner associates with, they may or may not be exposed to this informal “shadow” curriculum.)
Naturopathic doctors who use science to evaluate naturopathic medicine principles and practices will take science’s conclusions regarding homeopathy and vaccination (and other areas) seriously. They may wrestle with the studies, scour the methods section to see how they were carried out, or evaluate for bias. But once they conclude that science has reached a consensus, at least for now, they will change how they practice.
Naturopathic doctors who use naturopathic principles to evaluate science do not see science as an accurate arbiter of naturopathic medicine. These NDs, as Jonathan M. Berman says of early vaccine opponents in his Anti-Vaxxers: How to Challenge a Misinformed Movement, have already reached a conclusion and “approached the science as a source of prestige that could be borrowed for their arguments”.
The usual response to the inevitable clashes is to ask for “unity”. But some differences are not amenable to unification.
The root cause, if you will, of this attempt to enforce unity where it is not possible lies in two aspects of the naturopathic medical profession:
- A long-standing and historical reluctance to exclude any health-related concept, out of a desire to be inclusive of all healing methods. In this viewpoint, modern medicine is simple another way of approaching health and healing. When members raise objections to a practice that is not supported by the evidence, they are often told that the profession needs to embrace people on all side of the conflict.
- A focus on “naturopathic philosophy” and such principles as “doctor as teacher” while neglecting to articulate a reliable method for determining what, exactly, the doctor should teach – or recommend, or prescribe. “Find the cause” does not give its practitioners a foundation for determining what the cause is. And “treat the whole person” does not give guidance on how to treat.
Some may ask what is the harm in this attempt to embrace everything and exclude nothing. The harms are multiple.
- Presenting ineffective therapies as equivalent to effective ones endangers patients, full stop.
- Trying to present both homeoprophylaxis and FDA-authorized vaccinations as simply “matters of opinion” or diverging positions to be equally embraced is intellectually dishonest.
- False equivalency undermines the work of those NDs who uphold the science that they were first taught and now practice. These NDs include the many clinical supervisors entrusted with teaching students how to effectively and safely treat patients.
- While my observations are that the majority of NDs support vaccination to some degree, the lack of transparency about the persistence of anti-vaccination attitudes in the naturopathic profession presents a false picture to the public, potential students, and students – and legislators.
- Finally, making public statements that support vaccination, while providing anti-vaccination materials behind the scenes to the profession, sets an atmosphere that encourages similar behaviors in individuals.
The remedy for this is not easy, but it is necessary: the naturopathic medical profession must acknowledge the reality of its divisions and be transparent about their existence. Specifically, the naturopathic medical profession must own that while it does contain many practitioners who are science-based, it also still contains many practitioners and therapies that are not. It must be transparent that these practitioners still have significant influence in the profession, at least at the decision-making levels in national leadership. And if the profession wishes to genuinely be “rooted in science” then it must build a solid therapeutic repertoire based upon the foundation of science, as it appeared to be doing some 15 to 20 years ago. That will entail letting go of approaches that are incompatible with the scientific findings.
In this last year and a half, NDs I know have worked with their public health departments, going into nursing homes to track down COVID-19 outbreaks. They have suited up to give vaccinations at mass vaccination sites, week after week. They have gone to lengths to offer it in their clinics and vaccinate their patients. When these NDs became eligible for the COVID-19 vaccine, they received it and were public about it to encourage others. These NDs and their actions are as much a part of the profession, as is the ND arrested for violating the ethics and guidelines of that we were taught in naturopathic medical school.
I close with these statements from two ND organizations that are established supporters of vaccination:
“We condemn in the strongest terms the unethical practice of administering homeopathic substances as a form of immunization, as well as the unethical and illegal practice of falsifying vaccine records.” (NDs For Vaccines, “Condemning Fraud”)
“These allegations represent an egregious ethical violation and are diametrically opposed to the standards of primary care to which Naturopathic Physicians are trained….the academy [NAPCP] strongly recommends all members to follow CDC/ACIP immunization guidelines.” (Naturopathic Academy of Primary Care Physicians statement of 7/18/2021)
2/16/2022: minor typos corrected and the word “repertoire” added after “therapeutic” in the fifth paragraph from the end.
[1] Homeopathy as a whole – not just homeoprophylaxis – has not been proven to be any more effective than placebo. https://www.nccih.nih.gov/health/homeopathy
[2] The American Association of Naturopathic Physicians does not represent Canadian naturopathic doctors.
[3] I learned of the newsletter from a recipient. While sent to members only, AANP newsletters are at time shared more broadly in the naturopathic community. To my knowledge neither the email with the newsletter link nor the newsletter link itself are confidential. There was no statement of confidentiality in the email linking to the newsletter itself, nor copyright statement, and the articles in it were explicitly stated as intended for public distribution.
[4] Busse JW, Wilson K, Campbell JB. Attitudes towards vaccination among chiropractic and naturopathic students. Vaccine. 2008;26(49):6237-6243. doi:10.1016/j.vaccine.2008.07.020