Change is Inevitable
John H. Furlong, ND
Change in naturopathic medicine is inevitable. As it marches forward, it behooves us to recall the words of Dr John Bastyr: “The truth of our medicine will always win out, the truth of what we are doing will always survive.” The naturopathic profession must remember itself – its roots and its unique power – in the midst of change.
We have all seen the healing power of nature; we know the relationship between food, nutrients, medicinal plants, and mind-body dynamics. We have the knowledge to change the tremendous inequalities in healthcare. Do we have the Will?
Naturopathic medicine must become the medicine of the People, giving power back to them to control their own health and environment. WE can clean up the water in Flint AND treat those affected. WE can continue helping the 1 in 48 children that is born with some level of autism AND prevent this epidemic. WE can find ways to address the toxicity assailing our planet. Institutional racism is becoming more apparent, including discrepancies in healthcare due to race and economic status. WE know these inequalities ruin lives and communities. This polarization and the dysfunctional political dynamics that perpetuate such realities prevent advancement in our cities and neighborhoods. WE can facilitate the means to have the killing stop. Worldwide health challenges are profound: violent conflicts, potential for virulent epidemics due to poverty. WE can divest from organizations and corporations that support such atrocities.
The Power of Our Medicine
Our Medicine is powerful. Our philosophy can be consistent with the ecology of the planet. Our Medicine addresses the causes of disease and inherently strives to achieve balance. Our Medicine enhances health. However, due to the economic power and vested interest of the prevalent medical system, we appear to align ourselves more deeply in an imbalanced relationship with these “healthcare” institutions. While there are laudable cases where naturopathic doctors have established themselves as part of an interdisciplinary clinical team, these circumstances are the exception rather than the rule. In some of those relationships, we have forsaken our righteous place in healing in order to fit into the orthodox approach to medicine. I speak of this “rightful place” because the origins of naturopathic medicine span thousands of years. Our medicine is based upon the checks and balances of nature. It acknowledges that we are biologic beings subject to the rules and processes of biology. It is based upon myriad observations and investigations over time by intelligent peers of ours and from virtually all indigenous cultures. Ours is a potpourri of traditions, stemming from dedicated practitioners that were astute and scientific in their approach. All of these medicines and techniques evolved thousands of years before modern “scientific” thought evolved.
To the degree that we choose to emulate the prevailing orthodoxy of modern medical science, we neglect to foster the Vis medicatrix naturae, instead following a system of medicine that is young, immature, subject to significant conflicts of interest,1 and limited in its scope. Most importantly, as institutional medicine is typically practiced in the United States today, we are following a failed system. It is a system whose highest accomplishments are at the technological edges of medicine: surgery, bioengineering, pharmaceutical development, cybernetics. The majority of human beings on the planet do not need these advances; they need a healthy environment in which they and their children can flourish and live with reasonable opportunity for safety, joy, and optimizing their human potential. Modern “healthcare” in the United States transforms people into commodities to support its own existence. The entrenched and increasingly mimicked system of referrals2 perpetuates this dubious mutual-back-scratching arrangement. Naturopathic doctors relinquish the power of our medicine if we immediately make referrals of initially challenging cases, thus denying ourselves the opportunity to watch the Vis bring about changes that medical “science” naysays.
How We Survive
Why do we follow this ineffective path? One reason is that we appear to have achieved externally successful goals: institutional advancement, financial gain, social status, and establishment of exclusive societies that become self-serving in their own accomplishments. However, our standing in the US health hierarchy appears not to improve. We have more licensed states, greater options in practice with the efforts and dedication of many individuals and state organizations. However, we can choose to recognize that the thrust of healthcare in this country is the realm of pharma/ institutional medicine and the insurance industries. Their motivating focus appears to be how to maintain the 17% of the GDP that is their territory, not to enhance the health and well-being of the people. Is it possible that improved health for the majority of people was never the goal of the system we strive so hard to be part of?
Our oaths bind us to serve. As individual physicians we must remember those oaths… as many do. We have many MD and DO colleagues that serve their profession honorably with consummate skill and dedication. Those that do, often see the wisdom in our approach and welcome it. Alas, for the most part, these strident individuals and allies are not the ones making healthcare policy. We can choose to work together and prevent institutions from dehumanizing our patients; we can refuse association with an economic system that calls itself healthcare but delivers a far inferior result. We also need to tend to our own profession in a more balanced way… avoiding some of the pitfalls of a self-regulated profession.3 We can demonstrate our results with facts and outcome studies. WE cannot be satisfied with treating primarily the well-to-do with insurance.
For naturopathic doctors to survive, we can choose to embrace the activism growing in progressive movements worldwide, not only for our own viability, but also to counter the oppressive and fascist movements we see sprouting and finding fertile ground in unrest, inequality, and perverted justice. We must acknowledge that people of color, the poor, and disenfranchised are not prime users of naturopathic medicine. This must change. The crowded cities struggle with health issues and loss of human potential due to colonial and societal systems that continue to persist. What do we do to balance societal stresses? How do we help the transformation?
- Naturopathic physicians must do meaningful office-based research that is outcome-based, objectively documented, and inclusive of cost-accounting to demonstrate how dollars are spent for what results. Research should be prioritized to the region and the most pressing medical needs – research that is sensible to the people and which continues building our clinical sciences. We needn’t do research as does the orthodoxy, but we must gather and organize our data and experiences to move forward as a science. No one is going to do this work for us.
- We must resist mimicking the current system of medicine in the United States. The system is woefully ineffective at improving the health of the people. There are many dedicated and conscientious docs that are hindered by too much infrastructure and mixed priorities. Medicine must be streamlined and simplified. We can decide to be truly and institutionally “Alternative,” since the orthodoxy has failed in its charge.
- We must form deep and goal-oriented strategic alliances with the professions of acupuncture and chiropractic, and add to our primary health system the practice of massage therapy, physical/occupational therapy, and all forms of effective counseling.
- These associations (ND, LAc, DC) must present themselves as 1st-choice primary medicine, establishing a Wellness-based system that seeks to restore the health to people, while appropriately engaging technological or pharmaceutical medicine when dealing with conditions that fail to respond to 1st-choice methods.
- We can set as a national priority establishing the means for students to achieve forgiveness of their student loans. Examples: 2 years of working as primary-care naturopathic physicians in public health hospitals; working with Medicaid patients for 80% of a rural practice; serving in designated underserved areas, etc. Without the burden of loan repayment, naturopathic doctors can have more freedom to choose the type of practice they wish to pursue.
- We must be socially involved, not only in the Toastmasters clubs or Chambers of Commerce, but also in bringing efforts to actively transform our regions. Moving toward different systems of economic viability – such as health membership, direct-pay, or similar models of compensation for physicians – provides an alternative to the broken and tenuous system in which we find ourselves. Divesting from the insurance system is needed, as it is a major driver of the poor translation from medical knowledge to healthy people.
- We must honestly evaluate the financial incentives of our The sale of products through office practice represents a potential conflict of interest. I’m sure no graduate of a naturopathic program sells a product that they don’t just love… but what is really needful? We can be aware of and avoid nutritional “shotgun” medicine to enhance dispensary sales.
- Developing a different system of compensation,4 a more cooperative model, is essential. Membership-driven regionalized health hubs that include dispensaries, practitioners, and social-welfare services are an alternative to being a cog in our national healthcare fiasco. Read your insurance contracts carefully, including the small print! Take time and explore the attributes of direct-pay primary-care programs.5 See the example of the Oklahoma Surgical Center.6
- We must admit that much of what we do is not “standard of care,” and this is OK, since the standard of care is driven by Pharma… not by preventive, evidence-informed, and “do no harm” medicine. Standard of care is unlikely to ever be truly compatible with naturopathic medicine as long as insurance companies and Pharma run the show. Follow the money! Insurance compensation is not a given! Since it evolves according to rules written by the institutional medicine/insurance/pharma complex, we have no guarantees of reimbursements continuing with a Healthcare for All At this point, politically speaking, I think it is wishful thinking that naturopathic physicians are going to be included in a Healthcare for All debate. The “any willing provider” aspect of the Affordable Care Act (ACA) has been watered down to become meaningless despite the attempt at inclusiveness. See the “Provider Non-Discrimination” section of CCIIO’s ACA FAQ page.7 Insurance providers don’t have to accept licensed NDs into their system, and if they do, they are not obligated to pay what MDs are paid.
I welcome thoughts and other ideas on this topic, as we’re all in this together!
John H. Furlong, ND
- Angell M. Drug Companies & Doctors: A Story of Corruption. January 15, 2009. The New York Review of Books. Available at: https://www.nybooks.com/articles/2009/01/15/drug-companies-doctorsa-story-of-corruption/. Accessed August 3, 2019.
- Jauhar S. Referral System Turns Patients Into Commodities. May 25, 2009. The New York Times Web site. https://www.nytimes.com/2009/05/26/health/26essa.html. Accessed August 3, 2019.
- Jabr F. The Truth About Dentistry. May 2019. The Atlantic Web site. https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/. Accessed August 3, 2019.
- Hansen M. Health care is expensive. It’s time to treat the cause. October 29, 2018. Available at: https://www.kevinmd.com/blog/2018/10/health-care-is-expensive-its-time-to-treat-the-cause.html. Accessed August 5, 2019.
- Direct Primary Care Coalition. What is Direct Primary Care? Available at: https://www.dpcare.org/. Accessed July 18, 2019.
- Surgery Center of Oklahoma. Available at: https://surgerycenterok.com/. Accessed July 18, 2019.
- The Center for Consumer Information & Insurance Oversight. Affordable Care Act Implementation FAQs – Set 15. Provider Non-Discrimination. Available at: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs15.html. Accessed July 18, 2019.
Photo by Linus Nylund on Unsplash
John H. Furlong, ND, has maintained a private naturopathic medicine practice with LAc and MsT collaboration in eastern CT since graduating from Bastyr University in 1985. Dr Furlong worked 6 years for Genova Diagnostics, and also logged 5 years teaching gastroenterology, cardiology, neurology, pediatrics, and endocrinology for the University of Bridgeport’s ND program. Recent activities include presentations at the International Congress of Ethnobiology in Belem, Brazil, and participation in the Indigenous Peoples March and conference – an extension of the spirit and movement begun at Standing Rock. Dr Furlong is a minister and 18-year Danzante in the Mitotianilitztli celebration held yearly near Teotihuacan, Mexico.