Reconciling the Irreconcilable: Vaccines and Naturopathic Medicine

    When it comes to vaccines, perhaps the most frequent question I get is some version of “As a naturopath, do you recommend vaccines?” If you don’t have time to read the whole article you can stop here: my answer is always “yes”.

    Why? Because above all else I am a physician. This transcends any “naturopathic” or “conventional” categorization and requires that I present accurate and unbiased information about medicine to my patients. Evidence informed practice demands unflinching review of medical interventions both naturopathic and conventional. On both sides there are many techniques which fail to be strictly evidence based [1], and those found to be without sufficient evidence must be either validated or discarded without undue sentimentality.

    To this end, the evidence is clear: vaccines are safe and effective. Furthermore vaccines are consistent with the tenets of naturopathic practice. To explain this connection, I have listed the precepts of naturopathic practice below and will discuss the ways in which they align with vaccination.

    The Healing Power of Nature

    While the broadly beneficial aspects of the natural environment has been the subject of many a philosophical debate (and more than a few authors’ greatest works), we have recently been able to quantify some of the genuinely salubrious effects of time spent in a nature [2, 3]. I can only speak for myself, but cytokine production and NK cell activity aside, an afternoon outside can produce a fair amount of beneficial cardiovascular exercise as well.

    Our immune systems have evolved over the history of life on our planet to protect us from illness by responding to quickly and effectively against external threats to our health. Historically, the idea of vaccination came from exposing an individual to a small amount of cowpox, which was discovered to prevent smallpox, a much more serious and debilitating disease [4]. With refinements in technique and the advent of molecular medicine, we don’t need to slather children with cowpox to prevent smallpox (and not just because vaccination effectively eradicated the scourge of the vaccinia virus). Instead we can administer the necessary antigens in a quick, safe, and only slightly uncomfortable way: the intramuscular or subcutaneous injection. Not to mention oral vaccines and the now defunct inhaled vaccines. All of this benefit comes with a vanishingly small level of risk per dose of vaccine administered [5].

    Given the mechanism behind vaccination, I can’t think of anything more “natural” than using your body’s innate ability to create lasting immunity to diseases. Vaccines also have the added public health benefit of reducing the incidence of disease.

    Identify and Treat the Causes

    The source of vaccine-preventable illnesses are the causative organisms. Through the progress of modern research and the numerous scientific advancements since the inception of naturopathic practice we are able to not only understand the specific cause of these illnesses, but also engineer a precise and naturally-derived method to prevent these diseases in the first place. The idiom “an ounce of prevention is worth a pound of cure” comes to mind.

    First Do No Harm

    Failing to recommend preventive medical interventions which in turn contributes to both increased disease prevalence and reduced herd immunity is harmful, full stop. I would also contend that throwing patients out of our practices for vaccine hesitancy or refusal also causes a quantifiable harm to both personal and public health. The solution is education, and this dovetails with our next tenet: doctor as teacher.

    Doctor as Teacher

    We have a responsibility to educate our patients about the safety and efficacy of vaccines. It is likewise important that we meet our patients where they are to discuss the importance of vaccination, as well as the risks present when vaccination rates fall. We must take the time to carefully diffuse the minefield of disinformation, profiteering, fear mongering, and yes, even “fake news” found in the anti-vaccine havens of the internet. No vaccine hesitant patient has ever had their mind changed by a stern lecture and paternalistic attitude from their provider, and in my personal experience the best route has always been to systematically address specific concerns with the real evidence. This takes time, and not always possible when combined with the constraints of daily medical practice. So it becomes essential to curate a good educational resource list for patients. Vaxopedia is a fantastic place to start.

    Treat the Whole Person

    By taking a holistic view of the person as more than a collection of interrelated systems and associated symptoms, the physician can address an overall clinical gestalt and treat accordingly. From a hierarchical perspective, preventing debilitating illnesses allows our patients to pursue their higher order needs and self fulfilment. Furthermore, vaccines benefit not only the person receiving them, but their community as well. Health is not simply the absence of disease, but rather well being and freedom to focus on life’s other joys and challenges. Vaccination ensures that our patients maintain their health and can spend their time and resources affecting their communities in positive ways.

    Prevention

    Vaccination is without a doubt one of the crown jewels of preventive medicine. By utilizing our immune system’s automatic response to antigenic material, we can confer a natural immunity to illness, without having to suffer the potentially deleterious effects of the illness in the first place. Vaccines are good for individuals, for populations, and for those who have true contraindications to vaccination and rely on herd immunity. Preventing illness is far superior to treating it, and vaccines give the physician a powerful tool to keep healthy patients healthy, and protect others passively.

    The Bottom Line

    It is our duty to empower our patients to make decisions about their health with confidence that they are given the best available information. Vaccines are an essential, effective and elegant component of preventive medicine. Vaccination aligns with the all of the core tenets of naturopathy and anti-vaccine rhetoric is antithetical to the practice naturopathic medicine. We must work together to support our patient’s decisions to vaccinate, and educate those who are hesitant. NDs are in a unique position due to the perception that we are “outsiders” and therefore not “in the pocket of big pharma”. This perception sets a (false) dichotomy between “conventional” and “naturopathic”, and many patients look to us as a source of information that is free from the biases of “conventional medicine”. The educational pedigree of a medical provider should not influence vaccine endorsements, but the recommendation to vaccinate from an ND may carry more weight for those who preferentially select a naturopathic approach in their healthcare. Every additional patient protected with immunizations is a credit to the philosophy and foundations of our practice, and a benefit to the communities we serve.

     

    References

    1. Kane, Robert L, et al. “Examining the Quality of Evidence to Support the Effectiveness of Interventions: an Analysis of Systematic Reviews.” BMJ Open, BMJ Publishing Group, 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4861106/.
    2. Li, Qing. “Effect of Forest Bathing Trips on Human Immune Function.” SpringerLink, Springer. Japan, 25 Mar. 2009, link.springer.com/article/10.1007/s12199-008-0068-3
    3. Reynolds, Gretchen. “How Walking in Nature Changes the Brain.” The New York Times, The New York Times, 22 July 2015, well.blogs.nytimes.com/2015/07/22/how-nature-changes-the-brain/?ref=health.
    4. “The History Of Vaccines And Immunization: Familiar Patterns, New Challenges.” Health Affairs, www.healthaffairs.org/doi/abs/10.1377/hlthaff.24.3.611.
    5. “WHO Vaccine Reaction Rates Information Sheets.” World Health Organization, World Health Organization, www.who.int/vaccine_safety/initiative/tools/vaccinfosheets/en/.
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