Updated November 2018:
There has been a recent push to add a seventh guiding principle of naturopathic medicine [6]. The author believes that the proposed new principle, Scientia Critica (critical analysis), is a welcome and necessary addition to the original six. This article has been amended from its original form to include how vaccination meshes with this proposed seventh principle.
When it comes to vaccines, perhaps the most frequent question I get is some version of “As a naturopathic doctor, 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 that they are aligned with vaccines.
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 quickly and effectively against external threats to our health. Historically, 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 the 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 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 patient about the safety and efficacy of vaccines. It is likewise important that we meet our patients where they are, and 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 is 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. https://vaxopedia.org/2017/12/16/immunization-education-agreement/ 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-fulfillment. Furthermore, vaccines benefit not only the person receiving them, but their community as well. Health is not simply the absence of disease, but rather the well-being and freedom to focus on other 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.
Critical Analysis
The body of evidence supporting the use of vaccinations is overwhelmingly clear: immunizations effectively protect our communities and ourselves from disease, and reduce complications that necessitate high level medical interventions (e.g.; IV antibiotics, lumbar puncture, intubation, ECMO). Critical analysis of the frequently heard counterpoints that vaccines are in some way innately harmful, “unnatural”, toxic, or ineffective reveals no compelling evidence to support these claims. As such, we must educate our patients on the benefits of vaccines, and counsel the judicious application of this preventive medicine for all applicable patients.
The Bottom Line
Vaccines are an essential, effective and elegant component of preventive medicine. Vaccination aligns with all of the core tenets of naturopathy and anti-vaccine rhetoric is antithetical to the practice of naturopathic medicine. We must work together to support our patients’ decisions to vaccinate, and educate those who are hesitant. NDs are in a unique position due to the common perception that we are “outsiders” and therefore not “in the pocket of big pharma”. The perception that we are outsiders may be not be accurate. However, for many of our patients, the recommendation to vaccinate may carry more weight when it comes from an ND. Every patient protected from illness and its associated complications is a credit to the foundations of our practice, and a benefit to the communities we serve.
References
- 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/.
- 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.
- 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.
- “The History Of Vaccines And Immunization: Familiar Patterns, New Challenges.” Health Affairs, www.healthaffairs.org/doi/abs/10.1377/hlthaff.24.3.611.
- “WHO Vaccine Reaction Rates Information Sheets.” World Health Organization, World Health Organization, www.who.int/vaccine_safety/initiative/tools/vaccinfosheets/en/.
- Logan, Alan C., et al. “North American Naturopathic Medicine in the 21st Century: Time for a Seventh Guiding Principle – Scientia Critica.” Explore, 2 Aug. 2018, doi:10.1016/j.explore.2018.03.009.
Maxwell Cohen, ND
Max Cohen, ND is a naturopathic physician in Portland, Oregon. He currently works for a Federally Qualified Health Center (FQHC) providing primary care for a wide variety of patients. He is a member of the Board of Directors of the Naturopathic Academy of Primary Care Providers (NAPCP), as well as the Scientific Advisory Board for Boost Oregon.He completed his medical training and residency at the National University of Natural Medicine. Prior to medical school he worked as a microbiologist in a tuberculosis vaccine development lab. Twitter @MaxwellCohenND
