Foundations of Naturopathic Medicine Project Codifying our knowledge. It’s time THE HEALING POWER OF NATURE NATUROPATHIC MEDICINE’S PLACE IN THE HISTORY AND PHILOSOPHY OF MEDICAL SCIENCE Leanna J. Standish, ND, PhD, Chris Grontkowski, PhD, and Christa Louise, ND Version 4.0 May 1, 2006 Introduction The purpose of this chapter is to articulate and define, in as clear and succinct a manner as possible, the relationship between modern naturopathic medicine and allopathic medicine and the connections that both sets of medical principles have to the philosophy of science. Philosophy of Science Philosophy of science is a relatively recent field of specialization in philosophy, beginning roughly with Ernst Mach, Rudolph Carnap, and Karl Popper in the early 20th century, followed by Alfred North Whitehead, and coming to a flourishing development in the late 1950’s and early 1960’s with the contributions of Arthur Eddington and Werner Heisenberg, among others. The field can best be described as the effort to provide an epistemological basis for our understanding of nature through the natural sciences. Philosophers of science seek to answer the question “How do we know what we know about scientific matters or nature?” Traditionally, its methods have been logical, mathematical, and linguistic---all in the effort to make an ultimately metaphysical statement about what constitutes reality. The primary foci of inquiry have had to do with subject-object, mind-matter, and essence-appearance distinctions. The predominant values, somewhat simplistically stated, favor object over subject, matter over mind, and essential qualities over appearances. Hence they are almost reliably Cartesian, i.e., dualistic, in their approach. These are the values that constitute what in philosophy of science is called “the received view” (Heelan, 2001). That view derives from the Vienna Circle and reflects their positivistic empiricism, i.e., that scientific information can only be derived from physically measurable experiments. The approach is analytic/empirical and the goal is to give the most objective description of entities and events in nature. More recently, methods in philosophy of science can also be characterized as phenomenological. This is due primarily to the influence of Husserl, Heidegger, and Merleau-Ponty, who took seriously the aspects of phenomena (that which appears to observers as opposed to that which is [the thing in itself]) and developed a new, non-dualistic analysis that includes history, context, culture, and development. Add to this philosophical background the scientific theories of Einstein and Heisenberg and dualism faces enormously serious, fundamentally scientific challenges. Briefly, these are Einstein’s description of the conversion of matter into energy and vice versa, and Heisenberg’s introduction of quantum mechanics and the uncertainty principle. This challenges the simple role of the observer, since in attempting to ascertain the position of a subatomic particle, for example, the observer will enter the experiment and thus not be able to describe both position and momentum simultaneously. The history of Western medicine has followed very closely the development of the natural sciences: physics, chemistry, and biology. Intellectual inquiry, research programs, and clinical practices reflect those traditional values. The conventional 20th century “allopathic” explanatory strategy has been described as adhering to the following principles: objectivism, dualism, reductionism, positivism, determinism, and mechanism (Louise 2000). All of these principles have their basis in scientific materialism. This is a philosophical and scientific position that postulates and defends the primacy of material objects. Material objects are not only the fundamental entities of nature but also the primary epistemological categories. Human knowledge, if it to be considered knowledge at all and not mere hypothesis or opinion, is thus based on its correspondence to material objects. Ultimately, mind (and soul or spirit as analogous to mind) can be reduced to certain actions and interactions of physical objects. For example, consciousness can best be explained in neurological terms. A very new field in philosophy of science is phenomenology of medicine. Both Husserl and Heidegger criticized modern science for the way in which it values explanatory theories, i.e. “ideas” or “mental objects” over life-world processes. The life-world concept can be understood, for example, by studying the manner in which the human mind is embodied. There are several ways to approach this: the mind is embodied exclusively in the brain; possibly also in muscular or endocrine tissues; most broadly, the embodiment “extends also into the environment that sustains life and provides the meaningful physical space in which we live our conscious lives in society” (Heelan, © International Editors Retreat | Stevenson, Washington | April 1-5, 2007 – Chapter Draft 1 p. 51). Contemporary phenomenology of medicine postulates the concept of ‘Lifeworld’ as at least as valuable as conventional medicine and more inclusive of other areas of human experience. Each human subject “inherits . . . language, culture, community, a set of cares . . .that give meaning, structure, and purpose to the Lifeworld one shares with one or more communities” (Heelan p. 50) In this context the practice of medicine can be scientific in the traditional sense yet it can also embrace the broader aspects of human experience such as those exemplified in the naturopathic concept of holism. Phenomenology and metaphysics Although the term “phenomenon” has the original meaning in ancient Greek that is best translated as “appearance,” it does not necessarily follow that appearance is to be contrasted always with reality or essence. The effort of many of the early phenomenologists (Husserl, Heidegger, Gadamer, Merleau-Ponty) was not to advance such a dualism but to use the term “phenomenon” as a way of describing entities in a context. Another way of saying this is that instead of maintaining an ontological separation between essence and appearance, phenomenology emphasizes that our understanding of the natural world arises from the multiple ways in which that world appears. Heidegger stresses that phenomenology is an orientation toward what is given (die Sache selbst) in the life-world (Lebenswelt). As Patrick Heelan (2001) indicates in “The Lifeworld and Scientific Interpretation,” Husserl and Heidegger “criticized the ethos of modern science for a certain cultural bias it tends to encourage. This bias is in the way it privileges explanatory theories (‘ideas’ or ‘mental objects’) over life-world processes (‘phenomena’) with the consequence that the cultural hegemony of (what Aristotle called) ‘calculative thinking’ is promoted over the more foundational ‘meditative thinking.’ Calculative thinking is ordained toward management and control of things and people through rigid frameworks of organized thought. Meditative thinking has as its basic concern cultural meaning and meaning-change. . .” Heelan (2001) is careful to add that great and undeniable benefits follow from the calculative thinking of scientific research and investigation. These benefits include theoretical and technical advances in the sciences, including medicine. Thus, the phenomenological analysis of the life-world is not developed solely in opposition to traditional science but is an effort to enhance and enlarge it. An example of this is the recognition that the body is not merely a material object consisting of separate systems. It is also a locus of “dynamic processes and physical exchanges that mutually transform the functional ontology of the bodily parts, as well as the engagement of the whole body in the Lifeworld through conscious and unconscious functional exchanges.” (Heelan 2001, p. 49) In another passage Heelan writes, “The Lifeworld is an attempt to show, to point out, the historical river of individual human existence. What is thus revealed is the ontological dimension of human experience, prior to (because a grounding condition of) the epistemological” (p.50). Briefly then, the relationship between phenomenology and metaphysics can perhaps best be described as one that allows the phenomenological perspective to enrich traditional metaphysics by looking at that-which-is in perceptual, cultural, and historical diversity. In this way it is not unlike the relationship between traditional Western medicine and naturopathic medicine. Because of its phenomenological approach, for many naturopathic physicians, the clinical approach and the epistemological approach are one in the same. The basic tenets of scientific materialism Modern naturopathic medicine, while phenomenologically oriented, operates within a culture that espouses materialism as its basic ontology. The conventional modern western view of reality has been called alternately material realism, materialism, and scientific materialism. These terms are often used synonymously and interchangeably. Materialism, as a philosophy and cosmology, is a monistic philosophy. Modern materialism posits that there is only one thing in the universe - matter, and, thus, the term ‘monism’ applies. To be complete, we could safely say that the modern Western medical scientific view is based on monistic materialism. So that we can be clear about what we mean by monistic materialism and its application in scientific materialism, we will list here the basic tenets. 1. The universe is made of atoms which are matter. Matter is primary. 2. The movement of atoms and the subatomic particles of which they are comprised generates energy. Matter can be interconverted to energy, but matter can neither be created nor destroyed. 3. Time is irreversible and linear. 4. The universe has no purpose. It merely exists. 5. Biological life arose out of an initial accident: the random genesis of self-replicating proteins (see for example Richard Dawkins ‘The Selfish Gene’). 6. The human being is a complex multi-cellular organism; nothing more, nothing less. 2 7. Contingencies of survival (phylogenetic development through natural selection) and the contingencies of reinforcement (ontological development through classical and operant conditioning learning) are the two principles needed to account for human thought, action, and emotion. See for example, BF Skinner’s ‘About Behaviorism’ (1976) which elegantly argues that the human being is the joint effect of the contingencies of survival (phylogeny) and the contingencies of reinforcement (ontogeny). To suggest other causality violates Ockham’s razor. 8. Thought is private verbal behavior where the speaker (Broca’s area 41 of motor cortex) and the listener (Wernicke’s area in the auditory cortex) are in the same brain. 9. Since matter, including biological matter, is primary, human consciousness is an emergent property of matter. Consciousness is an emergent epiphenomenon of brain structure and physiology. Therefore, consciousness can have no direct effect on the environment outside of the skin of the organism other than through the effects of verbal behavior (i.e. language). 10. The organism stops at the skin. 11. Upward causation is the main causal analysis in scientific materialism and therefore reductionism is an appropriate method for understanding ‘underlying mechanisms’ of life. Upward causation is the notion that atoms give rise to molecules which give rise to biochemicals whose interaction produces cell physiology which gives rise to organ and inter-organ system physiology which gives rise to a complex nervous system and its associated brain neuroanatomy, neurochemistry, and neurophysiology which gives rise to human language which produces human culture and cultural evolution throughout linear human history. 12. The concepts of ‘soul’, ‘spirit’, and ‘god’ are social linguistic constructions that are meaningless because they refer to nothing verifiable by any sense organ. Within scientific materialism the concept of ‘vitalism’ is useless, misleading and meaningless. In summary, material realism and scientific materialism asserts five principles (Goswami 1993): Strong objectivity – there is an objective real world that can be known partially through the human senses Causal determinism – everything is caused by something else Locality – all interactions are mediated by signals through space-time Material monism – the universe consists of matter (and its by product energy) – and nothing else Epiphenomenalism – human consciousness is an epiphenomenon of brain activity The success of scientific materialism Twentieth century western medicine fully embraced scientific materialism. This orientation was codified by the Flexner Report widely disseminated in the 1960s. Twentieth century biomedicine proceeded forward with astonishing success by the application of material realism and utilizing a particular philosophy and scientific method called reductionism. The randomized clinical trial, a relatively new idea in science, was first suggested in the 1930s by the British statistician, Austin Bradford Hill. The revolutionary invention and widespread application of the randomized controlled clinical trial, the gold standard of evidence-based mainstream medicine, emerged from the monistic materialistic model of reality. Single physical variables such as pharmaceutical drug molecules can be measured, varied and their effect on a dependent variable can be measured and compared to an inert substance, the placebo. While the RCT has been a useful method for comparing one pharmaceutical to another it has not been without its critics. Harris Coulter, PhD, a well known advocate for medical homeopathy, published a thoughtful critique of the premises and assumptions inherent in controlled clinical trial in 1991 (Coulter 1991). Nevertheless, the evolution of science has led to the concept of the RCT for evaluating safety and efficacy of medicines and the successes of scientific materialism in medicine and health have been considerable. Some, but not all, naturopathic physicians believe that naturopathic medical research does not require a different model. Based on the exogenous germ theory of disease, drug treatment for many infectious diseases and widespread public health sanitation has led to a huge epidemiological transition in morbidity and mortality in the industrialized world. Median age of death in 1900 in the US was 47. Now, in just 100 years, median age of death is 77. It is reductionism and the application of statistical reasoning that led to the discovery that dirty water carries disease, that crop rotation produces better farm output, that penicillin from mold is an effective antibiotic drug, that estrogen therapy may be harmful to many women, and to the development of effective drugs against AIDS, to mention just a few examples of the success of scientific materialism and reductionism. Some naturopathic physicians accurately point out that drug treatment was not the primary cause of the decline of infectious disease. The bulk of the decline really began with the sanitation practices. We may have given more credit to antibiotics that is their due. Although the mean age of death in higher in 2000 compared to 1900, the 3 statistic is misleading because of all the infant deaths that occurred in the early part of the 20 th century. In other words, in 1900, if you reached the age of 40 you had a good chance of reaching the age of 65, but the mean was lower when the high infant mortality was added in. Some argue that while mortality and morbidity from infectious disease is lower now than 100 years ago, chronic disease mortality and morbidity has risen. Mind-Body theories Contemplation and study of the relationship of mind to body is customarily referred to in the history of philosophy as “the mind-body problem.” How the mind and the body relate is problematic in several ways: 1) How does an immaterial entity connect with and/or influence a material entity? 2) Which of the two entities has ontological and epistemological priority? 3) On what basis do we as human beings make judgments about these relationships? The first philosopher in the Western tradition to raise these issues in a sustained manner was Plato. He presents the position that mind (or soul or spirit) exist both prior to and after its sojourn in the body. St. Augustine in the theological tradition and Descartes in the scientific tradition have very strong Platonic roots. The questions raised by philosopher-scientists had to do with how human beings make the transition from perception or observation to knowledge, how reliable that transition is, and what kinds of scientific truths can be postulated upon it. There were a number of monistic theories including materialism (all mental events are reducible to physical entities or states), idealism (all so-called material objects are actually ideas, or reflections of a higher order of reality), and doubleaspect theories such as that of Spinoza which maintains that mind and body are simply two ways of looking at the whole just as are God and nature. There were also strong dualistic theories such as Descartes’ distinction between extended beings (bodies) and non-extended beings (minds). Descartes’ position is that we can only come to know material objects by first knowing the nature of our minds. Another, much less influential, dualistic theory is that of pre-established harmony. This is Leibniz’ position that all things, mental and material, are designed by God to be accurate reflections of each other. Twentieth century logical positivists such as Bertrand Russell and John Searle contributed much to the philosophy of science. They argued that we can only know what we can operationalize through language. The mind-body problem disappears for logical positivists. It is a linguistically meaningless question and should not, they believe, distract from the great empirical enterprise of modern science. For contemporary philosophy and science the most critical questions have to do with the relationship between consciousness and neurophysiology. It has often been argued that the mind is the result of the organization and activity of the brain. If actions, emotions, and thoughts of human beings were the result of brain activity then it follows that the human mind is also a complex biological machine. This premise underlies modern biological and computational neuroscience as well as artificial intelligence science and engineering. Other questions have to do with the mutual interactions between mind and body, with the possibility of communication between minds (as in mental telepathy, or ESP), and with the influence of mental states on physical disease processes and physical wellbeing, known by the researchers in this field as ‘distant mental influence on living systems (DMILS). Causality The concept of cause has traditionally been defined in terms of an object, an event which produces an effect. The effect can then be explained as a result of the cause. Although there was some effort among the Pre-Socratics and in Plato to address causal aspects, Aristotle was the first to give a systematic approach to the topic. He distinguished four kinds of causes: material, formal, efficient, and final. The material cause of an object is its physical matter; the formal cause is its concept or description; the efficient cause is that which brought it about; the final cause is the purpose of the object’s existence. For example, if we consider an object such as a portrait: the material cause would be paint on canvas; the formal cause would be the likeness of the person so represented; the efficient cause would be the artist; and the final cause would be to give aesthetic pleasure. Aristotle believed that only by addressing all four causes could any object be properly described. Modern science developed in many ways in opposition to Aristotle. Hence, the only aspect of causality that was valuable was that of efficient cause, the producer of the effect. The activities of empirical science concentrated on working backwards from the observed effect to the influence of the cause. There was also a very close connection between the concept of cause and that of the laws of nature. The cause was a necessary and/or sufficient condition for the existence of the effect. The major usage of the concept of causality in the history of science is empirical. A scientist searches for the cause of observed phenomena, e.g., for a certain bacterium or inflammation that results in symptoms of disease. The modern concept of causality has not changed much since the publication of David Hume’s “An Enquiry Concerning Human Understanding” in 1748. Hume’s view of causality became a central aspect of the 18th and 19th century British empiricism, and the central doctrine of 20th century science, including biology and medicine. Hume 4 utilized thought experiments with billiard balls to conclude that causality requires three conditions: contiguity in space, contiguity in time, and correlation. As we will see, 20th century evidence of non-local’ causality has shaken the foundations of scientific materialism because it violates Humes’ assertion that causality requires objects to touch each other, at the same moment in time. Evidence that is anomalous to scientific materialistic view of reality’s very nature comes not only from the micro world of subatomic particles, but also from the macro-world of neuroscience and medicine. Is vitalism a dualistic and/or useful concept? Vitalism as originally conceived in 19th century naturopathic medicine was a deeply dualistic concept. Interestingly, naturopathic medicine, while borrowing evidence from 20th century biomedical science for many of its therapies, did not follow the mainstream medical culture and did not embrace scientific materialism as its core philosophy. Rather this medical sub-culture continued to adhere to an idealistic and vitalistic philosophy. German homeopathy, a deeply vitalistic medical doctrine, influenced naturopathic medicine and it is perhaps homeopathy that has been most responsible for keeping vitalism alive in naturopathic medicine as its core philosophy. Modern western medicine elsewhere had moved away from dualism, embracing instead a monistic materialistic perspective; that the brain and the mind are one; the brain causes the mind and not vice versa; that the concept of soul is meaningless. Naturopathic doctors, unlike their conventionally trained medical (‘MD’) colleagues, continued to use language that included’ mind’, ‘body’, and ‘spirit’, sometimes a kind of triad, other times a kind of dualism. When naturopathic medicine had its resurgence in the last 25 years of the 20th century detractors criticized the medicine and its vitalistic philosophy as a quaint anachronism and thus undeserving of serious consideration. However, now in the beginning of the 21st century naturopathic medicine is in the forefront of the resurgence of monistic idealism in medical science. Vitalism is a useful concept only if scientific materialism is an incomplete or, perhaps, even incorrect philosophy. We will argue that within the ‘new science’ and the ‘new biology’ naturopathic medicine finds its home and its 21st century leadership role. Naturopathic physicians, even today, however, continue to use outdated language while invoking vitalism. As scientific evidence from the physical and biological sciences grows and is generating the so called ‘new science’, the precepts of monistic idealism are gaining ascendancy once more. One can now be a vitalist without invoking dualism. What is primary in the universe is not matter (the brain). What appears to be primary in the universe is consciousness and/or information. Body and mind are one. Soul and body are one. Both upward and downward causation occur in nature. Classical physics and ‘energy medicine’ Many students of naturopathic medicine confuse ‘energy’ medicine with quantum entanglement. Energy medicine’s basic concept is that the living organism is both shaped by and emits electromagnetic fields, or biofields. Oschman (2000) argues in his book ‘Energy Medicine’ that these electromagnetic fields may provide a clearer representation of the body and its physiology than conventional diagnostic tools. Basic energy medicine propositions do not require quantum theory, non locality, complementarity, or entanglement to describe or explain them: 1) living organisms create (or are created by) biomagnetic fields that are measurable and extend beyond the skin; 2) these fields change continuously in relation to events taking place within the body. It is important to avoid confusion regarding ideas emerging from the new discipline called ‘energy medicine’ that do and do not refer to quantum nonlocality and entanglement outside of space-time. We refer to the former as ‘radical energy medicine’ propositions. These include: 1) biofields are unified at a higher level of organization than the body itself; 2) these fields are interconnected and have non-local qualities. In order for any phenomenon to meet the definition of ‘non-local’ three qualities are required. The that causal connections involving the fields must be unmitigated (no change in force with time or distance), unmediated (outside of space), and simultaneous (outside of time). We can agree that living organisms have fields emanating from them without invoking nonlocal interactions. Biofields can be understood within classical physics. It is non-local interactions that require a non-Euclidean and therefore a quantum approach. Highly sophisticated technology is required for us to know that any phenomenon, any cause-effect relationship, has non-local characteristics. The existence of biological energy fields is adequately explained within classical physics and does not require quantum theory or a new science beyond Einsteinian scientific materialism Is there evidence that scientific materialism is incomplete or even wrong? The simple answer is yes. Experimental data from quantum physics, biology, physiology, and medicine indicate that there is more going on in the universe than the propositions of scientific materialism would indicate. In the next section we will show that there is evidence that causality does not require locality in space or time; that the 5 organism does not end at the skin; that mental events can alter physical reality; that time is not linear; and that consciousness may be more than an epiphenomenon of brain function. Data from key experiments in quantum physics The first experimental data came from Thomas Young’s physics experiments with elementary particles in the 1920s. Young used the double-slit experimental design to show that photons have properties of both matter and energy (the complementary principle) and that observation of elementary particles changes their nature (Heisenberg uncertainty principle). In an experimental test of Bell’s Theorem, Aspect, et. al. 1982 were the first to demonstrate non-local entanglement of elementary particles. In this experiment two correlated photons are emitted by the same atom and move in opposite directions. In whatever actuality one photon manifests from its quantum possibilities (e.g. polarity, spin) via measurement (i.e., observation by a conscious being), the other photon manifests the same actuality even though it is at a distance and there is no signal between the photons. Aspect et al concluded that the two photons influence one another via a non-local relationship that is outside of time. The change in the state of one photon instantly changes the state of the other distant photon. This interaction is not influenced by lead shielding (unmitigated), it is unmediated (distance between the photons does not alter the entanglement of states), and is simultaneous, requiring no time for the state of the correlated photon to change. The theory of quantum mechanics is derived from experiments such as these using elementary particles. This theory postulates that the properties of any atom, or any elementary particle) such as spin, location, or momentum, exist in all possible states at once – as long as they remain unmeasured. The role of the observer cannot be ignored. In the parlance of quantum mechanics, observation collapses the wave form into a thing, a particle. In the quantum mechanics view, the observer creates reality by making an observation that collapses the waveform of possible states into one state. Some theoretical physicists have generated broad ontological theories based on these observations. For example, Amit Goswami, PhD, in his book ‘The Self Aware Universe’ concludes that ‘objects appear from a transcendent possibility domain into the domain of manifestation, in the presence of awareness of a brain-mind, in order for measurement to be completed’ (p ___). Such assertions rely on the concept that non-locality and entanglement occur not just at the micro level of the elementary particle, but also on the macro level of reality where we live, the world of objects, bodies, space and time. It was not until the last decade of the 20th century that evidence came from biology showing that non-local interactions and entanglement occur at the macro level. The first evidence for macro-entanglement came from neurophysiology experiments in humans. Data from neuroscience In 1994 Grinberg-Zylberbaum, et. al. published a paper entitled ‘The Einstein-Poldolsky-Rosen paradox in the brain: the transferred potential’. Using electroencephalographically recorded visual evoked potentials these authors reported that EEG signals were ‘transferred’ between human subjects who were separated from each other physically and sensorially. The authors claimed that the observed EEG coherence is an example of non-local information transfer and thus provided the first evidence of ‘macro entanglement’. Standish et al 2005 replicated this basic finding in a larger group of human subjects using more sophisticated engineering and statistical signal detection methods. This same research group replicated the same findings using functional magnetic resonance imaging technology (Standish, et. al. 2003; Richards, et. al. 2005). Recently Achterberg, et. al. (2005) have used the same fMRI methods in similarly well controlled studies to show that healers can alter brain activity of a paired human subject in the scanner. Changes in blood oxygen level dependent signaling was observed when healers were asked to ‘send’ distant healing intention to another person who was located inside a lead shielded experimental chamber. While these EEG and fMRI data are intriguing it is premature to claim that these data are evidence of non local effects. Sophisticated techniques will be required to determine if the neural brain-to-brain ‘signal’ meets the criteria for non-locality – unmitigated, unmediated, and simultaneous. We do not yet know if the brain signals observed in these experiments diminish as a function of distance (thus not an electromagnetic field effect), is undisturbed regardless of shielding, or that the correlated brain signaling does not require time. However, some of the ‘distant healing’ studies support the hypothesis that such human-to-human interactions may have non local characteristics. Data from medicine and ‘field effect’ studies Biology and medicine have produced several pieces of evidence that suggest that conscious intention can alter living systems, including human beings, at a distance. In his book “Healing Research” (1993) Benor reviewed the scientific literature describing the effects of human intention on living systems at a distance. He reviews published 6 data on ‘remote healing’ studies with enzymes, cells, fungi, plants, animals, and humans. While not all studies showed statistically significant effects, many do, with replication of results across laboratories. In 1988 the first peer-reviewed medical journal report on distant healing research in humans appeared (Byrd 1988). In this prospective randomized controlled trial 393 adults admitted to an acute coronary unit were assigned to one of two arms: those who received intercessory prayer from a prayer group or the control arm which received standard care only. Byrd reported statistically significant results in that fewer patients receiving distant prayer required intubation or ventilation, required antibiotics, had cardiopulmonary arrests, developed pneumonia or required diuretic medication. In 1998 Sicher, Targ, Moore, and Smith reported statistically significant effects in a population of AIDS patients randomized to receive distant healing by a group of healers. Harris, et. al. in 1999 replicated the original findings of Byrd’s coronary care unit findings in a group of 990 consecutive patients admitted to the coronary care critical care unit. Astin, et. al. (2000) published a meta-analysis of the efficacy of ‘distant healing’ in the Annals of Internal Medicine. They reported that in a total of 23 well-designed trials 57% showed statistically significant results and that the binomial probability of obtaining these results across trials was less than 0.0000008. Since 2000 there have been other data published showing similar effects of ‘distant intention’ and ‘distant healing’ (Lobo et al 2001, Krucoff et al 2001). While the mechanism for such distant effects of ‘intention’ is presently unknown, some scientists assert that these effects are evidence of quantum mechanics’ non locality and entanglement at the macro level. The proper experiments to determine whether the reported effects of intention on distant human patients show non-local entanglement properties have yet to be done. A series of ‘field consciousness’ studies have been conducted by Radin, et. al. Using random number generators located in 17 locations all over the world, Radin’s group has shown that when many people are simultaneously attending to one thing, increasing order (less randomness) is observed in the outputs of random number generators. Radin asserts that these experiments demonstrate the existence of ‘field consciousness’ effects. Similarly, there is a bit of research showing that group meditation can influence crime rates (Assimakis and Dillbeck 1995). These authors utilize the field consciousness effect to explain their results. Whether these fields, if they exist, have non local characteristics remains unanswered. It is a mistake to conclude, without the required parametric studies, that these data are evidence of macro-entanglement. Science as a Process With the publication of Thomas Kuhn’s “Structure of Scientific Revolutions” in 1962 a new perspective on the nature of science was recognized and widely supported. Briefly, Kuhn distinguishes between normal science and revolutionary science. Kuhn (1970) defines a scientific paradigm1 as “a constellation of achievements--concepts, values, techniques, etc.--shared by a scientific community and used by that community to define legitimate problems and solutions”. As a world view (interpretation of the world) it serves as an explanatory model of a reality that cannot be completely encompassed (Cassidy, 1994). Central to the prevailing paradigm throughout the 20th century, the scientific method is a set of assumptions about how to discover knowledge. Kuhn calls this the normal science. Normal science refers to theories and empirical methods almost uniformly accepted among scientists at a given time. Revolutionary science is the term he uses to describe a new theory, the result of unexpected observations, that first challenges then ultimate replaces the older paradigm. Examples include Copernican astronomy replacing the Ptolemaic view, Lavoisier’s discovery of oxygen replacing the phlogiston theory, Einstein’s incorporation of time into the theory of relativity replacing the three-dimensional Newtonian universe, and Heisenberg’s development of quantum mechanics establishing wave-particle duality and challenging the traditional concept of objectivity. The normal science will continue under its prevailing paradigm until persistent anomalies are observed that cannot be fit into the old paradigm. Inconsistencies that are observed repeatedly will eventually provoke a crisis for the science, a search for a new paradigm will begin, and in one discontinuous shift, the world view will change. David L. Hull’s 1988 “Science as a Process” analyzes the development of science in evolutionary rather than revolutionary terms. Hull argues for an understanding of science as a selection process similar to Darwinian natural selection and as the product of the way scientists live and work. The conditions in which scientific concepts evolve are sociocultural, but the mechanisms are similar to those in evolutionary biology. They are, like biological species, entities which evolve, which change and adapt as conditions allow them to flourish or fade. Hull notes that some research programs are more successful than others and he counts as reasons for their success being in the right network (laboratories, journals, etc), having one terminology become dominant, making sure that other scientists 1 From the Greek paradeigma, meaning pattern. 7 can use one’s work and give credit for it. Many research programs fail, “leaving a literature as calcified and causally inert as fossils of extinct species” (p. 372). The relevance of both of these theories of science to the principles and practices of medicine cannot be overemphasized. The history of medicine in the 20th century is a compelling tale of scientific and technological triumphs over a vast number of diseases. These successes illustrate the effectiveness of basic scientific research, carefully controlled experiments, peer review, experimental replicability, authoritative publication, and continuing clinical application. In addition to scientific issues, these successes also raised issues in medical ethics and epistemology, both of which have been the subject of philosophical inquiry in the last quarter of the century. Examples include the journal “Philosophy and Medicine”, begun in 1975 ( ), Pellegrino and Thomasma’s “A Philosophical Basis of Medicine” (1981) and Thagard’s “How Scientists Explain Disease” (1999). “Medicine is a truly scientific endeavor. It shares with chemistry and physics the aim of understanding physical processes. Medicine as science studies man by observation, mensuration, hypothesis formulation, and experiment under controlled conditions. In studying man as object, it follows the canons of good science. . . But the basic sciences by themselves are not sufficient to constitute medicine either as clinical science or medical practice. Medicine, even as science, must encompass the special complexities of man as subject interacting with man as object. . .” (Pellegrino p 23 ). Thus, philosophy of medicine returns in very fundamental ways to questions of mind-body relationships and causal connections. Social issues that influenced the CAM paradigm shift What causes ‘paradigm shifts’ in science? Two forces seem to converge together in the history of science to create ‘scientific paradigm shifts’ and ‘scientific revolution’: 1) anomalous data and 2) urgent social changes. Many believe that we are in the midst of a paradigm shift in medical science. The term ‘anomalous data’ refers to experimental data that do not conform to conventional dogma concerning how the universe works. The central dogma of modern medical science is that of scientific materialism. ‘Anomalous’ experimental data that do not fit with classical Newtonian physics have been gathering since the early decades of the 20th century in physics. However, there are scientific data from other fields are considered ‘anomalous’ since they do not fit well with scientific materialism. There are now compilations of ‘anomalous’ data, not just from the subatomic micro world but also in macro systems, such as living creatures, including humans. Those data come from the neurosciences and distant healing medical research. Data from distant healing research and neuroscience are considered anomalous data because the experimental results do not fit in with the conventional scientific view founded in scientific materialism. Great changes occurring in mainstream allopathic medicine are also responsible for the ‘paradigm shift’ in medicine. The allopathic medical model is based on nomothetic science (i.e., one characterized by inviolable scientific laws). Disease is differentiated from illness. Disease is assumed to have a single etiology (an external agents such as bacteria or viruses (germs), carcinogens, or injuries, or an internal agent such as a biochemical reaction or a defective nucleic acid sequence (genes or aging)). Treatment is the “magic bullet” that will counteract the pathology. The allopathic taxonomy is based on disease types (ICD codes), and the disease determines the treatment, that is, the physician treats the symptoms of the disease, not the patient. In diagnosis and assessment of disease outcomes, preeminent importance is given to data obtained from laboratory and other highly technological instruments (rather than from data given by the patient). The presumption is that all “legitimate” therapies must have undergone clinical trials and must have an identifiable mechanism of action. The goal of therapy is “cure”, and health outcomes result primarily from the actions of healthcare professionals, with patients “receiving” care (Engel, 1977). There is a clear distinction between the physician and the patient. The allopathic model is based on allopathic3 principles. The model is primarily pharmacological (most treatment is through the use of chemical agents) or surgical (removing the offending organ or surgically repairing a damaged one). Allopathic medicine is aimed at relieving or palliating symptoms and suppressing specific pathology.4 Allopathic therapies usually have negative unintended effects (side effects5) that can weaken and damage the body.6 In terms of research and 3 Allopathy (allo = opposite, path = suffering) is a system of treating disease by producing a condition that is incompatible with or antagonistic to the symptom that is being treated. 4 Suppression is defined by Taber (1993, p 1866) as “the repression of external manifestations of a morbid condition.” A key principle of naturopathic medicine is that symptoms should not be suppressed. 5 From a purely pharmacological perspective, drugs do not have side effects but only effects. Physicians then differentiate the effects they intend from those they do not (Ullman, 1997). The intended positive effects are called the specific effects, unintended positive effects are call non-specific effects, and unintended negative effects are called side effects. 6 According to a recent article in the Journal of the American Medical Association (JAMA), serious adverse drug reactions (ADRs) are experienced by more than 2 million patients and lead to more than 100,000 deaths in the U.S. per year (Lazarou, Pomeranz, & Corey, 1998). This places ADRs as the 8 treatment, the concept of generalizability asserts that the effect of treatment on one demographic group (i.e., by sex, age, race, socioeconomic status, etc.) can be assumed to also be the effect of that same treatment on another demographic group. This allopathic model cannot account for two phenomena. First, many people who are exposed to a pathogen do not contract the disease. Second, people who have never been exposed to a certain pathogen can exhibit symptoms that precisely mimic the pathophysiological stat, i.e., people can experience distress in the absence of any disease that has a specific pathology (Engel, 1977). Examples of disease without distress (e.g., HIV-positive individuals who never develop symptoms of HIV disease) and distress without disease (e.g., a patient who has been diagnosed with chronic fatigue syndrome) do not fit within the allopathic model. The therapies that originated based on a bacteriology-driven experimental science cannot be effectively applied to the complex chronic disorders that characterize the majority of current patient problems (Dachter, 1997). The validity of the allopathic model begins to break down when the disease state is not caused by an infectious pathogen or traumatic injury (the vector model), and when it is recognized that most diseases have multifactorial etiology.7 By the 1960s, as fewer of the health problems presenting at the physician’s office fit the vector model, the need for a new model within which to fit this unaccountable evidence was becoming apparent. The 20th century has given birth and been witness to epidemics such as AIDS and cancer, cold war and the daily possibility of nuclear annihilation, space travel to the moon, daily possibility of chemical warfare annihilation, and global warming. Anomalous data in physics, physiology, brain research, and medicine also arose in the time of the civil rights movement, followed by the women’s and gay liberation movements, and most recently the alternative medicine movement. All these major social changes have synergized with anomalous scientific data from multiple disciplines to create the transitioning state of medical science in which we now find ourselves in the first decade of the 21st century. Professional and lay texts often claim that science proceeds by the presentation of anomalous data in the face of the current scientific belief. Examples include Copernicus’ observations and calculations and Keppler’s data. In late 20th century medical sciences anomalous data have been reported in peripheral neurophysiology (Braud and Schlitz 1997) and central neurophysiology (Grinberg-Zylberbaum et al, Wallach’s group; Standish; Achterberg; Richards; Kozak). The common view of how change happens in science is that that the experiments and mathematical calculations that produced anomalous experimental findings that ultimately led to momentous changes in the scientific paradigm originated de novo from the minds of individual, gifted scientists and the continued confrontation with the anomalous data finally won out as the older generation died off and the next generation of scientists could incorporate the data into their worldview. Surely there is an interaction between the anomalous data and the social context. An important question remains. What spurred the scientists to even look for the phenomenon that they claimed to exist while at risk of flying in the face of conventional worldview, practice and wisdom? Few, if any, of the anomalous data that created a paradigm shift were discovered accidentally. Each of the scientists set out to look for something that no one before had thought or tried to look for. In the prevailing belief system of scientific materialism the phenomenon being sought (e.g., healing at a distance) cannot exist. Many of the scientific experiments considered now instrumental in the ‘new science’ and ‘new biology’ and ‘integrated medicine’ as part of this idea were inspired by other fields and other traditions. The spread of Buddhism, and we would add Hinduism, to the west was considered by Will Durant to be the single most important change agent in western civilization to date. The notion of downward causation that generates much of the new science today germinated within theology. Western science medicine has been firmly based in a different view of reality than the cosmology of the east. Scientific materialism has been the underlying philosophy and epistemology of the last 400 years of western science and medicine. Given the data from quantum physics, neurophysiology, and distant healing research we must conclude that scientific materialism as a view of nature and reality is, at best, incomplete. Reductionism, Objectivism, and Mechanism in Modern Medicine In terms of the principles underlying the scientific method, examples of anomalous data which led to irreconcilable differences include the following: fifth or sixth leading cause of death in the U.S. (behind heart disease, cancer, stroke, and pulmonary disease). In comparison, the number of deaths due to (non-ADR-related) accidents is 90,000 (Murray, 1995). Furthermore, some drugs actually cause the problem they were intended to address; for example, drug-induced rebound headache (Mathew, 1993). 7 The doctrine of specific etiology developed by Pasteur (1873) is a mechanistic medical model which specifies that for each illness there is a single necessary and sufficient causal agent or pathogen. 9 1. Reductionism: Reductionism presupposes that complex phenomena are explainable in terms of simpler component phenomena, that conditions can be reduced to a single etiology, and that qualitative properties can be reduced to quantitative properties (e.g., the experience of music can be reduced to analysis of frequencies. It assumes that by disassembling a system into its component parts and then analyzing the workings of each, an understanding of the system as a whole can be achieved. This approach overlooks the loss of information (i.e., in terms of organizing principles) that occurs when a system is taken apart (Kilvington, 1997). Water may be decomposed into hydrogen and oxygen, but studying the properties of each component will not increase an understanding of the properties of the whole. The increasing understanding of the interrelatedness of components within systems and between systems, and the limitations imposed when trying to understand processes in isolation make the results of reductionist research incomplete at best. 2. Determinism: Determinism asserts that phenomena can be predicted accurately from knowledge of scientific law and initial conditions, and that any given cause will, always and inevitably, lead to the same effect. In this view, the biological determinant is necessary and sufficient for the disease, the diagnosis, and the cure (Drossman, 1998). This principle holds true only if all other things are equal. But in a complex, dynamic, living system, countless variables intervene so that all other things are never equal. For example, of ten people who are exposed to a virus, only some will get sick. The major intervening variable may be the state of each person’s immune system, but the “state of the immune system” is itself influenced by countless variables. In the subatomic realm, nothing can ever be known with certainty (Heisenberg, 1958). The implication of this for research is that uncertainty will always exist at some fundamental level, and reductionism must, at some point (even if only at the subatomic level), fail to provide absolute answers.8 Uncertainty, where essential reality cannot be known with certainty, replaces determinism, where physical “reality” is considered to be fixed, determined, and measurable (Zohar, 1990). 3. Linear (unidirectional) causality: Linear causality assumes that any effect can be traced back to a single prior cause, that cause and effect are distinct from each other, that effect follows cause closely in time, and that the effect is proportional to the cause. Recognition that there are always multiple intervening variables causing multiple interactions, and these multiple interactions lead to complex non-linear phenomena renders the assumption of linear causality invalid. In 1979, Samual Viasrub (editor of the Journal of the American Medical Association) stated: a. ‘New cybernetic mechanisms have added further complexity to understanding causality in human physiology. Cause and effect no longer bear a straight linear relationship to each other. Circular mechanisms of positive and negative feedback have taken over in the operational depths of homeostasis. The chain of causation is fast dissolving before our eyes to be replaced by some form of invariable association that does not lend itself readily to graphic, mathematical, or any other representation’. (p. 830) The belief that effect must be proportional to the cause is disputed by the concept of collateral energy, where energy for the response comes not from the amount of force exerted, but from within the system. The energy for the effect existed (as potential) before the event that precipitated the disease (e.g., a tiny virus that causes an epidemic). 4. Mechanism: The mechanistic view of nature asserts that life processes are linearly determined and can be explained completely by reference to laws governing physics and chemistry. The principle is closely related to strict determinism: All that happens has a definite cause that gives rise to a definite effect (Capra, 1975), but it also pertains to the assumption that a cause must be at the same level of the effect. The concept of mechanism implies that an effect must be spatially contiguous to (or at the same level as) the cause. Research has demonstrated that disturbance at one level of an organism (e.g., the social environment) can have an effect at another level (e.g., the physical health of a person) (e.g., Pennebaker, Kiecolt-Glaser, & Glaser, 1988). 5. Positivism (sensate empiricism): The focus in the scientific method is on sensate empiricism (i.e., that which can be observed with the senses) to the exclusion of other modes of knowing. Information can be derived only from physically measurable data. Consequently psychology was excluded from “scientific study” until the early part of the 20th century when behavioral psychologists argued that only those behaviors that could be seen and described were valid topics for study (i.e., when “psychology” became 8 Systems scientists believe that reductionism fails long before the subatomic level is reached. 10 empirically observable). Coincidental with the development of more sophisticated psychometric methods, behavioral psychology began to be viewed as at least a “soft” science. Heisenberg (1958) and Roethlisberger and Dickson (1939, the “Hawthorne effect”9) argued that the process of measuring something (someone) changes the behavior. Uncertainty remains regarding the reliability of measurement in psychological constructs10 and is compounded by the realization that multiple interactions lead to complex non-linear phenomena. The noetic sciences are founded on the belief that alternative ways of knowing (e.g., intuition) may also be valid (empirical and publicly reproducible). 6. Objectivism: The scientific method presupposes value-free objectivity, i.e., the only valid reality is separate from experience and devoid of any higher purpose. In the Cartesian paradigm it was believed that scientific descriptions could be objective (i.e., independent of observer and the method of questioning). For most of the 20th century, there has been a steadily accumulating challenge to the notion that there exists objective knowledge that can be unbiased in interpretations or impartial in its assumptions (Olds, 1992). Scientists do not deal with “truth”; at best, they deal with limited and approximate descriptions of reality. In the words of Heisenberg, “What we observe is not nature itself, but nature exposed to our method of questioning” (1958, p. 58). While physics had long been considered the ultimate “objective” science for which the scientific method was most successful, by the early 20th century scientists were beginning to observe anomalies that did not fit the current theories. When exploring the atomic and subatomic world, physicists discovered that atomic phenomena could not be described in terms of classical concepts. These questions regarding long-held conceptions about the nature of reality at the physical level shook the foundation of normal science. Even when all physical (material) variables have been controlled, consciousness appears able to exert an influence on the outcome. Primary evidence for this effect comes from quantum physics, where the universe is seen as a dynamic and inseparable whole that always includes the observer in an integral way (Capra, 1975). 7. Dualism: Cartesian dualism asserted that mind and body are separate. In medical science this is exemplified by the belief that disease and illness are classified as either organic (i.e., having an objectively defined etiology) or functional (i.e., having no specific etiology or pathophysiology), or that disease is objective and “illness” is subjective. The “old” paradigm has provided a means of gaining much knowledge about one level at which the world operates (i.e., the materialistic, or physical--particulate-- level). This means of acquiring information is not invalid; it is, however, incomplete. Nor is the preceding discussion meant to imply that skepticism is not an important aspect of any scientific research endeavor. The primary implication is that a phenomenon as complex as healing requires more than can be explained by reductionistic models that are based on simple deterministic assumptions. An open attitude, one which rigorously and continuously re-examines its founding assumptions, is vital to the notion of sound model development and research. See Table 1. While the reductionistic approach has contributed enormously to scientific progress, its limitations in understanding the complexities of biological systems are evident. Many authors base their conclusions on information gleaned from a single level (e.g., a self-report survey), using analyses which do not generally take complex interactions into account. The current paradigm of molecular reductionism cannot account for the dynamic self-organizing and self-healing properties of living systems. Table 1 Philosophical differences between the old paradigm (which governs allopathic medicine) and the new emerging paradigm (which governs naturopathic medicine). Old Paradigm New Paradigm Rationalism noetics Analysis synthesis The “Hawthorne effect” refers to changes in the behavior of people, usually for the better, that occur simply because the participants were involved in a research study. “Hawthorne” was the name of the factory at which the effect was first observed. 10 Richmond and Peterson (1997) maintain that psychological variables can be quantified although they cannot be measured. Furthermore, just because we do not have the instruments to measure something today does not mean that it does not exist (e.g., blood pressure existed long before the sphygmomanometer was invented). Just as a microscope enables the human eye to see things that are not visible with the naked eye, computerized tomography (CT) and positron emission tomography (PET) scanning assist the visualization of variance in absorption or blood flow (metabolism). These instruments provide patterns of information regarding physiological function. As progress is made toward identifying the physiological alterations brought about by symbolic stimuli, it is conceivable that someday emotions may be measured using similar types of instruments. 9 11 Knowledge understanding Authoritarianism collaboration Quantity quality Reductionism holism linear causality mutual causality Mechanism uncertainty "normal science" systems science mechanical isolation systemic integration states processes goal-seeking purpose-seeking The naturopathic philosophical stand in 21 st century medicine Twenty first century naturopathic and conventional medical students continue to be trained in the basic sciences that rely on 19th and 20th century scientific materialism as a basic premise. However, the ‘old’ science depends on basic assumptions such as objectivism, reductionism, and mechanism that are revealing themselves limiting, incomplete, and inade2qauet for 21st century medicine. The present day naturopathic medical student is perhaps more aware than conventional medical students of the anomalous data emerging from the new science that argues that macro ‘quantum-type’ entanglement and nonlocality may be operating in effects that have been observed during distant brain signaling and distant healing experiments. Yet medical education has yet to fully update its basic sciences in light of the new biology. This is true at both conventional and naturopathic medical colleges. Both cultures, while asserting monistic materialism as a fundamental doctrine, refer in linguistic confusion to a fuzzy kind of dualism that separates mind and body. For example, so called ‘mind body medicine’ is a leading modality in the so called new ‘integrative medicine’. The very phrase implies a kind of duality. With the start of a new century, medical school faculty and their students should eschew the imprecise thinking of Cartesian dualism and continue to incorporate the monistic view. A fundamental difference between conventional and naturopathic medicine is the naturopathic insistence of the value of vitalism as an orienting philosophy, and the Vis medicatrix naturae, the healing power of nature, as its core principle. In modern naturopathic medicine the ‘vis’ is defined as the ‘self organizing principle of living organisms’ or the ‘life force’. If a monistic and holistic approach is taken, then vitalism in the naturopathic medical context refers to the coherence of the organism, its extended field, and complex, possible, nonlocal interactions between organisms over large distances. Rather than apologizing for its insistence on vitalism as a principle, modern naturopathic medicine should reclaim the Vis as a fundamental principle while modernizing the concept via monism, quantum mechanics, and the ‘new biology’. The naturopathic medical view of holism is also a phenomenological one that may be unique to naturopathic medicine. Conclusion Naturopathic medicine distinguishes itself philosophically from mainstream medicine by its core principle Vis medicatrix naturae, the healing power of nature. Its insistence on referring to the ‘vital force’ has served to isolate, and perhaps sideline, naturopathic medicine from mainstream conventional and pharmaceutical medicine of the second half of the 20th century, which has been historically based exclusively on scientific materialism. However, the experimental findings from quantum mechanics in physics, neuroscience, and the distant healing literature suggests that scientific materialism is an incomplete description of realty and thus cannot be the sole philosophy of modern medicine. The findings of the ‘new science’ support the concept of biological field effects, macroentanglement, non-local interaction, and downward causation. A ‘new medicine’ is emerging in the 21st century. 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