Naturopathy: Report of the
Australian Committee of Inquiry (1977)

INTRODUCTION

Throughout the States the Committee of Inquiry was aware of a considerable interest in naturopathy, both as an activity of alternative health practitioners and as a part of the current reaction against orthodox and conventional life-styles now exhibited by many members of the general public. The term 'naturopathy' in Australia is used to encompass a wide range of alternative healing 'modalities', which vary a great deal from one practitioner or clinic to another. There is not the homogeneity of theoretical bases or techniques and methodology seen in the practice of spinal manipulation, particularly as it is practised by members of the Australian Chiropractors' Association.

'Naturopathy' in Australia has come to have two interpretations: one as an umbrella term for the several treatment modalities commonly used by 'natural' therapists; the other to describe one modality in addition to those of chiropractic, osteopathy, herbalism, homoeopathy and acupuncture which makes use of fasting, dietary change and little-used and ill-defined techniques such as hydrotherapy. In this section of the Report 'naturopathy' or 'natural therapy' are used to describe therapeutic regimes other than spinal manipulation. The justification for the expropriation of the word 'natural' by these unorthodox therapists is, however, obscure.

Most naturopaths profess the use of spinal manipulation to some degree, others make more extensive use of homoeopathic remedies, dietary advice, herbs, mineral salts or vitamins.

Quite commonly, iridology is practised by this group, as also is acupuncture. Spinal manipulation is, however, not the predominant therapy. In addition, the Committee encountered a small number of practitioners attempting more unusual therapeutic approaches, such as zone therapy, colonic lavage and fasting, and some used, or were interested in following the ideas of, radiesthesia and Kirlian photography.

In this report, the subject of naturopathy is first considered as a whole, and then the major diagnostic techniques and therapeutic approaches are discussed in detail. Homoeopathy forms the subject of a separate chapter, since it often constitutes the principal therapeutic system of many alternative practitioners and is one of the subjects the Committee was specifically asked to investigate. The Committee received a number of submissions from homoeopaths and herbalists who claimed a much more specialized knowledge of these fields than did naturopaths generally.

The Committee found 'naturopathy' very difficult to define, and was unable to find any clear-cut statement capable of adequately describing the activities of this group of practitioners in such a way that any expectation of their behaviour as consultants could be predicted by a patient. There is no generally adopted system of diagnosis or treatment and the patients' only expectation is that drugs and surgery would not be used.

HISTORICAL BACKGROUND

The basic concept of naturopathy centres around the age-old belief that the body can be maintained in a state of health by wholesome 'natural' foods, the extensive use of water, fresh air and sunlight, together with periods of fasting. This belief is held throughout the world by naturopaths and is discussed in most popular books on fringe medicine (Inglis, 1964). It is believed that adherence to such a natural way of life will encourage the body to resist disease without recourse to drugs or surgery. It is recognised, however, that sickness and disease do exist, and when they strike, remedies derived from herbs or minerals already provided by nature will enable the body to become more resistant and thus health will be restored. The object of the practising naturopath is therefore as much to maintain good health as to treat illness. The Committee heard a number of witnesses who stated that-they followed the advice of naturopaths in maintaining their health but resorted to orthodox medicine for conditions which they recognised as clearly responsive to conventional therapy. The value of medical treatment for infectious diseases and trauma was accepted but not for less clearly defined disorders.

Naturopathy,was already well-established before the time of Hippocrates when the priest-physicians of the Aesculapian order established temples of health where patients were bathed, massaged and fasted, and the sites of these temples were often adjacent to mineral springs from which water could be used both externally and internally. A secure basis for naturopathy lies in the recognition of the inherent recuperative power of the body, or vis mediatrix naturae of Hippocrates.

During the 19th century, the use of water as a specific form of therapy came into vogue under the leadership of Vincent Preissnitz (1800-1851) in Germany, and it rapidly became a popular medical treatment in Europe and America. Hydrotherapy was more popularly accepted in Europe and at the major spas there were clinics run by medical practitioners whose patients enjoyed a period of abstinence and relaxation, and also followed a natural diet comprising largely fresh fruits and vegetables. Special treatments were often available and frequently included massage and manipulation.

Among the naturopaths there were grades of acceptance of the compromise between a severe regimen of 'hygienic living', in which all forms of remedial treatment were deplored, and a more practical viewpoint which used natural agents of all kinds in a therapeutic regime. In modern naturopathy, controversy still centres around the extent to which the naturopathic method should be adopting the methods of other related systems, such as herbalism and homoeopathy. In Germany and Switzerland in the 1960s, it was estimated (Inglis, 1964) that of some 12,500 naturopaths. probably 10,000 were doctors who were duly qualified and registered. In Britain, on the other hand, relatively few doctors were interested in naturopathy and the greater proportion of its proponents were not medically qualified, so that a strong feeling was engendered that all unorthodox practitioners were 'quacks' (Inglis, 1964).

Naturopathy in the U.S.A. took a somewhat different direction with the establishment of luxury clinics where patients could follow weight reduction regimes, obtain cosmetic surgery, gain assistance in reduction in alcohol consumption, while enjoying a luxurious and relaxing sojourn in pleasant surroundings. A wide range of treatments is offered in these residential clinics in the U.S.A., often under the guidance or proprietorship of doctors. Essentially this development was to give the affluent client moral support to assume a more heal thy way of life.

In Britain, a College of Naturopathy was established in 1948 to organise naturopathy as a profession, and examinations were held with the aim of compiling a register of naturopaths. The academic barriers could not be strict, since the beliefs and practices of naturopaths were so wide and so variable; yet there appears to have been some attempt to regulate against the inclusion of clearly unethical and fraudulent practitioners.

Naturopathy has experienced historically two major stimuli which have encouraged renewed interest in its philosophy and caused a resurgence in the number of adherents to the system.

First, the violent nature of medicine in the 18th and the early 19th centuries repelled many devoted healers and instead of enemas, emetics, the use of purgatives and the application of leeches, they sought gentler methods involving heat and herbal medicines. The development of homoeopathy was a direct result of such efforts. More recently, beginning in the 1950s, it became apparent that many of the drugs developed by the pharmaceutical industry had unwanted side-effects which sometimes appeared to be as bad as the initial indication for the use of the drug, and again naturopathy and homoeopathy came back into favour to some extent.

NATUROPATHY AS NOW PRACTISED IN AUSTRALIA

In Australia naturopathy appears to have been of little interest and to have been pursued in a desultory manner until the Inquiries of the New South Wales and Victorian State Governments and the establishment of the present Committee of Inquiry brought home to the practitioner the need for unification through State and Federal Associations concerned with the standards of practice and education.

As a result, the South Pacific Council for Natural Therapies was formed in July, 1975, by amalgamation of the South Pacific Federation of Natural Therapeutics and the Australian Council for Natural Therapies (see Chapter 1 and Appendix 3). The South Pacific Council is an umbrella organisation that includes member groups having naturopathy as their main interest, but does not include the major organisations of specialized practitioners of manipulative therapy. Furthermore, there are several associations and colleges not affiliated with any other organisation, and without exception these include practitioners using a wide variety of modalities. Reference to the organisational chart (Appendix 4) shows the complexity of the present situation.

The object of these associations appears to be primarily the presentation of submissions to the Committee of Inquiry, together with the limitation of the entry of new practitioners who do not pass through the 'educational' programmes laid down by these organisations. There appears to be an effort to upgrade the practice of naturopathy as a result.

The Committee visited the colleges offering courses in various aspects of naturopathy. In every case, it was considered that the standards in the orthodox basic biomedical sciences were disappointingly low. It is quite apparent that there is no cohesive body of knowledge on any aspect of naturopathy, at least, as expounded in these colleges, which constitute a 'clinical or therapeutic component' to follow the basic science training.

Although the Committee found the syllabuses of many colleges were reasonable in their coverage of basic biomedical sciences on paper, the actual instruction bore little relationship to the documented course. In no case was any practical work of any consequence available. The lectures which were attended by the Committee varied from the dictation of textbook material to a slow, but reasonably methodical, exposition of the terminology of medical sciences, at a level of dictionary definitions, without the benefit of depth or the understanding of mechanisms or the broader significance of the concepts. The Committee did not see any significant teaching of the various therapeutic approaches favoured by naturopaths. Persons reported to be particularly interested in homoeopathy, Bach's floral remedies or mineral salts were interviewed, but no systematic courses in the choice and use of these therapies were seen in the various colleges. The Committee was left with the impression that the choice of therapeutic regime was based on the general whim of the naturopath and since the suggested applications in the various textbooks and dispensations overlap to an enormous extent no specific indications are or can be taught.

Naturopathic practice, for the most part, is conducted privately with the patient visiting the practitioner. There are, at the present time, two residential naturopathic clinics which are modelled on the lines of the spas in Europe, at which patients may stay with a view to taking longer courses on therapy, of which fasting is an important factor. The Committee confined its attention, however, to the private office practitioners, since they handle the vast majority of patients.

The diagnostic procedures vary considerably between practitioners, and the history given by the patient plays a major part. Most naturopaths use iridology as a diagnostic aid. A few measure blood pressure, and a stethoscope is a common accoutrement of the office. Urine analysis by simple tests (e.g. Clinistix) is sometimes used.

The Committee was informed by many practitioners that they were not allowed, by law, to use a number of simple, non-invasive, standard diagnostic procedures. Yet in the hands of properly-trained people, the proper use of such instruments as the ophthalmoscope, stethoscope, and pneumograph should reveal indications of conditions that would call for referral to specialists. With the exception of Queensland (The Medical Acts, 1939-1966), there are, in fact, no legal barriers to the use of such instruments. The naturopaths claimed considerable success in cases of asthma and yet the simple checking of respiratory parameters was never done.

It was claimed by many naturopaths that the patient usually came with knowledge of the nature of the complaint from previous medical consultations, so extensive diagnostic work-up was not necessary.

The therapy offered was one or more of the following:

(i) dietary advice

(ii) manipulation

(iii) provision of homoeopathic remedies of a herbal, or mineral nature

(iv) acupuncture

(v) zone therapy

(vi) colonic lavage.

These are discussed individually below.

Patients visited the naturopath several times as all of the treatments appeared to involve a correction of general life style as well as a continued course of treatment. The establishment of rapport, understanding and friendship between the " practitioner and patient seemed in all cases to be a significant component of naturopathic behaviour.

The Committee did not make a practice of interviewing patients since such information would have been difficult to assess, but as a result of the surveys made by Professor Western and his colleagues, as well as from impressions gained throughout the entire Inquiry, it is clear that a considerable degree of patient-satisfaction is obtained from naturopathic practitioners. We are of the opinion that the naturopath assists many patients who have been dissatisfied with medical advice, who suffer from complaints with a strong psychosomatic component, or who are chronically sick but have not received sufficient support in the orthodox situation. It must be concluded that no small responsibility for this situation lies with the pressure upon the medical profession and in particular its emphasis on a technological orientation rather than the more leisurely approach of the naturopath to the patients' problems.

THE NATUROPATHIC THERAPIES AND DIAGNOSTIC TECHNIQUES

'Biochemic remedies' are preparations of minerals commonly prescribed by naturopaths. In Australia the most commonly employed preparations are those manufactured by Blackmore Laboratories under the proprietary name of 'Celloids'.

This commercial enterprise was started by Mr M.C.H. Blackmore, who was a self-trained naturopath. Generally, 'Celloids' follow the principles of 'The Biochemic School of Medicine' of Schuessler (Chapman, 1973). This use of biochemic remedies is based on the concept that many disorders stem from mineral deficiencies in the diet which may arise directly, or as a result of eating vegetables and fruits from plants grown on soil deficient in essential minerals.

It is claimed of 'Celloids' and other biochemic remedies that they are manufactured in such a way that the absorption of the minerals into the body is facilitated, but there is no evidence for this.

Schuessler's use of the term 'biochemic' is not to be confused with the science of biochemistry; it simply means the 'chemicals of life', and comprises the following twelve substances:

calcium fluoride

calcium phosphate

calcium sulphate

ferrous phosphate

potassium chloride

potassium monohydrogen phosphate

potassium sulphate

magnesium hydrogen phosphate

sodium chloride

sodium monohydrogen phosphate

sodium sulphate

silicon dioxide

Whereas Schuessler used a homoeopathic approach to mineral therapy and believed that very prolonged grinding and mixing of the chemicals were essential to make them accessible to the body cells, Blackmore's manufacturing methods follow conventional pharmaceutical procedures such as granulation and tabletting.

Mr Alfred Jacka, President of the National Association of Naturopaths (Australia) in his report to the Victorian Committee of Inquiry, made the following statement about the use of 'Celloids':

'The selection of the appropriate remedies are based on certain symptoms which are the reflection of the underlying causes but, with a number of practitioners further confirmed by iris diagnosis (to be referred to later). The symptomatology which is the guide to the use of these remedies has been found by long experience to be similar to that of the Dr Schuessler tissue salts (pioneered along homoeopathic lines in the last century) but these Celloid remedies are not homoeopathic as they involve comparatively large amounts of medicinal material prepared in a quite different way. We regard the Celloids as detoxifying, energizing and able, in the great majority of cases, to repair diseased internal organs and parts. They work well in practically every internal medication case we tackle.'

The Committee of Inquiry visited the Blackmore Laboratories at Balgowlah, N.S.W. and found the premises to be generally similar to those of many of the smaller pharmaceutical companies. The Committee was informed that the distribution of the 'Celloid' preparations was entirely through naturopaths (including naturopaths who also regarded themselves as chiropractors), some of whom were shareholders of the Company. The Committee was aware that the premises had been inspected by officers of the Health Commission of New South Wales and found to conform to the Code of Good Manufacturing Practice. However, the Committee noted that analytical control of the raw materials and finished products was rudimentary. The identity of herbal materials appeared to rest with the supplier, usually an overseas broker.

It is difficult to come to grips with the scientific basis of 'biochemic' therapies. When Schuessler refers to 'cell-salt deficiency', he means 'localized deficiency in certain cells or groups of cells with molecular disturbance of the' salts there present'; it does not imply a deficiency in the total amount of any given salt in the body. None of the followers of this technique who were interviewed by the Committee, nor any authors whose works have been seen by the Committee, has or had the means to determine an alleged localized deficiency of certain cells in respect of any mineral.

Biochemic cannot be described as a scientific theory in the sense that the term 'theory' is used by scientists. It is, in fact, nothing more than pure imagination.

The associated therapeutic advice and patient management proposed by Schuessler for various conditions is generally that which would be appropriate for their treatment, without the addition of a 'biochemic' remedy. To the extent that a biochemic prescription may be helpful, it is in the nature of a placebo response, which is accepted as a significant and often effective therapy. The Committee cannot accept" that any processes of manufacture such as grinding or comminution can affect the absorption or utilization of mineral salts by the body other than in a manner predicted by the laws of physical chemistry and related sciences.

The Committee gained the strong impression that the Blackmore preparations were being manufactured simply because a demand existed and Mr M. Blackmore was quite frank in agreeing that the scientific basis for their use was unexplored. He was apparently quite happy with the suggestion that clinical trials of his preparations should be undertaken although it was recognised by all parties that the task and the limited would preclude this unless efficacy were to be the magnitude of distribution of these products legislation requiring proof of introduced.

Herbalism dates back to antiquity and stems from the observation that animals resort to eating particular plants when they are sick. Most civilizations have a folk-lore of herbal medicine and many of our most important drugs have been derived directly from this source. The alkaloids of opium, ipecacuanha and cinchona are outstanding examples. They were used in medicine in the crude herbal form or as galenical preparations such as tinctures, extracts, infusions, etc. for many centuries, although the pure active principles of herbs are now preferred.

It is generally accepted that a great deal of herbal folk-lore has little scientific foundation and that which has, has already been very thoroughly explored by pharmaceutical manufacturers in search of marketable preparations. It is unlikely that herbal preparations will yield additional drugs of major importance.

The herbalist does not accept this view and claims that herbs do not function in the accepted pharmacological manner. It is claimed that although this may certainly sometimes be the case, our present state of knowledge is inadequate to explain the action of many herbs and it is postulated that sometimes they stimulate the body to fight against disease in a manner which science is as yet unable to explain.

In 1864 a National Institute of Medical Herbalists was founded to prove that herbalism was a valid alternative system to orthodox pharmacotherapeutics. This body, N.I.M.H., attempted to establish standards of education for its members which resulted in disunity among herbalists. Herbalism suffered a recession for many decades, due very largely to the successful development of drugs by chemists either by isolation from plant and animal sources or synthetically, and the consequent
success of the pharmaceutical industry.

It is reported that in Britain there has been a revival of interest in herbalism since the 1960s and the N.I.M.H. now runs a school training qualified herbalists and enforces a code of ethics among its members. The Medicines Act of 1968 in the U.K. recognised the prescription of herbs by a medically qualified herbalist.

The Committee has had the opportunity to study syllabuses and examine the prospectuses of the N.I.M.H. courses as well as one conducted by the National Herbalists Association of Australia.

The Committee does not believe that the courses offered in Australia do more than provide a general outline of human anatomy and physiology at an elementary level, with the section on the 'Therapeutic Properties of Herbs' following the general lines of traditional materia medica. No intensive study of the chemistry of plant constituents is required, nor is there any section of the course dealing with pathology or disease states. It would be expected that a herbalist would have an extensive knowledge of the chemical constituents of plants, and yet this field appears to be entirely neglected.

The Committee has studied many books on herbalism and examined the 'British Herbal Pharmacopoeia' published by the British Herbal Medicine Association. The latter resembles the British Pharmacopoeia, or the British Pharmacopoeial Codex in format and comprises a list of monographs arranged alphabetically and covering an apparently wide range of herbs which are not referred to in either of these official compendia. The monographs define the herb and describe its identification in the terms of pharmacognosy. (Pharmacognosy is the art and science of the recognition of the sources of drugs of plant origin.) Each monograph contains therapeutic indications, many of which must be regarded as dangerous and unacceptable. The Committee finds no support for the therapeutic indications of preparations listed in the British Herbal Pharmacopoeia for diabetes mellitus, epilepsy, heart failure, hernia, to name only a few of the conditions enumerated which are responsive to orthodox drug treatment or surgery.

Frequently the Committee's attention has been drawn to the reputation and standing of a number of eminent persons whose names are associated with herbal publications. It must be pointed out that the inclusion of the name of an expert in pharmacognosy only means that his expertise has been used by the compilers, and does not necessarily extend to an endorsement or recognition of statements outside the area of such professionalism.

It is, however, surprising to the Committee that in some cases medical men who have had the benefit of some years of basic scientific training can apparently accept some of the statements referred to.

Herbal lists nowadays appear only to include substances available without restriction by any type of Poisons Act legislation, and consequently do not contain potent. substances. It is the considered opinion of the Committee that any properties which may be manifest as a result of administration of herbs must be produced by one or more substances capable of being isolated and chemically identified. This has always proved to be the case in the past, and even in cases where a herbal preparation has produced effects not fully accountable by the already known active principles, it has been shown that further study reveals additional active constituents. In recent years, improved methods such as gas-liquid chromatography and mass spectroscopy make the identification of minute amounts of chemical components almost a matter of routine. The Committee cannot agree with any hypothesis that herbal medicine can produce effects unaccountable in pharmacological terms due to active principles that are incapable of chemical extraction and concentration.

The Committee recognises that there may be substances as yet unisolated that may have weak pharmacological effects, or may be synergistic with substances already isolated, and these may be isolated in the future. However, the thoroughness with which the pharmaceutical industry has surveyed the global flora for pharmacologically active substances renders the probability of any significant range of effective herbal medicine remaining most unlikely.

It is recognised that herbal medicines may act as placebos and produce effects beyond those expected in suitable cases, particularly where the sickness or disability is not readily related to a clearly defined pathological state. On balance, though, the Committee finds little valid scientific basis for the use of herbal remedies as modern therapeutic agents, other than those having pharmacopoeial recognition.

Bach's floral remedies

A variant of herbalism, followed by only a few adherents, is based on a different concept, first put forward by Edward Bach. Bach was a medical graduate who practised as a consultant in Harley Street for some 20 years, but in 1930 abandoned his practice and turned to natural healing with herbs and flowers. He believed that these remedies should not be sought for, but come upon instinctively, and he tried to sense intuitively those plants which had a more spiritual effect on man. He devised 38 different remedies.

A good deal of information about the preparation and use of these remedies was obtained from Mrs M. Edwards, President of The Dr Edward Bach Society of New South Wales. Floral remedies are not produced by juicing or pounding like other herbal preparations, but by preparing essences by the 'sun method' or the 'boiling method'. For either method, the flowers have to be picked at about 9 a.m. on a fine sunny morning. In the sun method, the flowers are floated on a sterilized plain glass bowl (not cut-glass or oven-glass) filled with clear stream water and left in the sun for exactly three hours; it is then mixed with an equal volume of brandy. This essence, which is said to keep indefinitely, is used to make 'stock bottles' by diluting two drops in one ounce of brandy; two: drops of the stock are diluted with one teaspoon of brandy to give one ounce of the medicine actually used by the patient, four drops at a time.

Mrs Edwards informed the Committee that the remedies were effective with humans, animals or plants; she had successfully treated a 'weak-willed' orange tree after she moved it.

Some of the remedies and the conditions for which they are used are:

A mixture of five remedies, called the 'rescue remedy' is alleged to be beneficial in saving life in an emergency, pending medical care (Chancellor, 1971).

Bach's work clearly took him much further beyond the realms of scientific possibility than that of more conventional herbalists.

Dietary advice and nutritional therapy

The naturopath believes that the modern diet is not conducive to health either because foods are impaired or degraded by processing, or contain injurious additives, or are otherwise abnormal as a result of the use of pesticides and weedicides, and the lack of use of organic fertilizers.

In some States, the giving of dietary advice for payment is restricted to registered dietitians. Naturopaths, therefore, often distribute leaflets containing dietary advice free of charge to their patients. The Committee considers that sound nutritional advice is not nearly as readily available to the public as it should be. This has been recognised by the National Health and Medical Research Council. The recent establishment of Chairs in Nutrition in two Australian Universities and the establishment of the Division of Human Nutrition in C.S.I.R.O. is an encouraging sign.

Medical students in Australia receive very little or no formal teaching in nutrition and in a short consultation with a patient are rarely in a position to give dietetic advice as part of their therapeutic measures. Apart from dietitians, very few nutritionists exist in Australia.

The naturopath has entered this area by default, and has acquired an undue importance. The advice given by naturopaths is variable in quality. Some of the literature submitted to the Committee contained substantially sound, orthodox nutritional advice, whereas the advice offered by a minority of naturopaths was potentially hazardous (e.g., the avoidance of all sources of protein by children under five years of age).

Dietary advice needs to be disseminated widely, yet we found that naturopaths and their patients were largely unaware of government publications such as 'Eat Better for Less', which are readily available and free. Naturopaths could, with advantage, avail themselves of much sound dietary advice which, although emanating from orthodox sources, closely parallels their own views as often expressed to the Committee. Their often expressed reaction against highly processed convenience foods as a major source of calorie intake is, in fact, also a serious cause of concern to health authorities generally.

Inappropriate nutrition is one of the causal factors in a number of diseases common amongst the Australian population and there is great concern among nutritionists in the States that insufficient attention is being devoted to improving nutritional education.

We understand that the Standing Committee on Nutrition of the National Health and Medical Research Council is drawing attention to the present unsatisfactory state and has recommended an investigation into the component of nutritional teaching in the medical schools of Australia.

The only health worker with any depth of training in human nutrition is the dietitian-nutritionist and the total number employed full-time in Australia was only 255 in 1976. At the end of 1976 there were only five full-time dietitians employed in community health in New South Wales and a report on the Training of Dietitian/Nutritionists in New South Wales, prepared in 1975 emphasizes the acute shortage of such professionals in the health services.

There is a great deal of interest in food and nutrition through the media but sound nutrition information is not readily accessible to the public.

The Committee recommends that nutrition education should become a more significant part of medical education at all levels and urges the need for a study of the eating habits of Australians in relation to health.

The Committee is of the opinion that much of the nutritional advice offered by naturopaths for the maintenance of. good health is reasonable, although naturopaths are by no means the sole source of such commonsense advice. However, the Committee does not support the submission of the professional nutritionists/dietitians that they should have an exclusive right to the purveying of dietary advice generally. In the case of dietary advice offered specifically as part of a definite therapeutic regime, the Committee saw no evidence to indicate that naturopaths had any special competence, and considered that they should not offer such advice unless they were trained in nutrition and dietetics to the appropriate level. In fact, in the case of patients with serious metabolic illnesses their management by diet should be restricted to qualified nutritionist/dietitians.

Vitamin therapy

Many naturopaths and a few scientists and medical practitioners claim that the 'natural' vitamin preparations, such as rose hip vitamin C, are better than the synthetic pure chemical forms of the vitamins. They claim that other agents in the 'natural' preparations enhance the effect of the vitamins. Statements with a pejorative connotation are sometimes made about synthetic vitamins, such as: 'they are made from coal-tar'. It can be scientifically established whether a synthetic product is identical with a 'natural' product by modern analytical procedures. In the absence of any discrepancy in such tests, the equivalence of the two forms must be accepted. Modern chemical analytical methods enable the purity of synthetic vitamins to be stated quite precisely; and if necessary they can be prepared free of any substances used as intermediates in the synthesis, although a detailed understanding of the safety and freedom from toxicity of such intermediates may render such high purification an expensive and unnecessary step. In marketed. commodities for which claims are made about vitamin content, the content is so established by tests which cannot discriminate between added and 'natural' content, and nutritionally the only point of significance is the content.

When it comes to some of the preparations that are prescribed and dispensed by naturopaths, there is no such standardization and control over the amounts of vitamins alleged to be in the preparations, whereas similar preparations made by major pharmaceutical companies will have been subjected to vigorous control for purity and content and will be as efficacious and much cheaper. The Committee recommends that all products distributed by natural therapists or health food stores should be subjected to quality control in the same manner as pharmaceutical products generally distributed through the pharmacist.

Zone therapy

This technique is not much used in Australia. The alleged basis is that the body is divided into ten zones, each of which is connected to an individual finger and toe and to a specific region on the soles of the feet; gentle massage of the appropriate point stimulates reflexes which restore normal blood flow in the corresponding zone and rids the organs and glands therein of accumulated waste. The theory was invented by an American nose and throat surgeon, Dr William Fitzgerald, and taken up by a number of others, and particularly by Benedict Lust (often regarded as the father of American naturopathy) who wrote a book on the subject. Lust described the treatment of many diseases by pressure on appropriate fingers, either manually or with rubber bands or clothes pegs. In Australia, the therapy is administered by gently rubbing and pressing selected spots on the soles of the feet and the big toes.

Mr G. Thompson, who occasionally uses zone therapy, told the Committee that it was time-consuming, and sometimes he had to work for an hour before it became effective. However, it had a healing effect on the liver, gall bladder, heart, varicose veins, haemorrhoids, stuffed sinuses, prostate and stomach. Conditions such as pernicious anaemia, women's disorders, and hay fever have allegedly been relieved.

Clearly the theory on which the treatment is based is contrary to all scientific knowledge of the innervation of the foot, although some overall sense of improvement resulting from the treatment might be attributed to counter-irritation.

Iris diagnosis or Iridology

Iris diagnosis is a method which is claimed by many people to be capable of revealing disease states in the body when used alone or as an adjunct to other diagnostic procedures. It is often referred to as 'iridology'.

Historical background

Iridology is claimed to be a science based on an accidental discovery by Ignatz von Peczely who, when a boy of ten years in Hungary, was playing with an owl and happened to break one of its legs. 'He also happened to notice the appearance of a dark stripe in the lower region of the iris of the bird, and later found that this darkened area corresponded to the location of the broken leg' (Jensen, 1952). This incident made a lasting impression in the mind of the future doctor and later in the hospital wards he was able to observe the eyes of patients and construct the first chart of the iris. This was about 1836,and in 1866 von Peczely published his first book on the iris.

A Swedish homoeopath Nils Liljequist (1893) also wrote a similar book on 'Diagnosis from the Eye' at about the same time. Since then many books have been written on iris diagnosis or iridology and it has a very extensive following throughout the world today, especially among alternative health practitioners.

The philosophical concept

In order to make use of observations of the iris it is claimed that a definite philosophy must be understood and applied. Basically it is that 'the eyes are the windows of the soul' and bear witness to the workings and conditions of every organ of the body. The 'perfect' eye is said to show no flaws so the striations of the iris are free of holes, distortion of the fibres, and deposits, and is of a perfect colour. 'The person who studies iridology is able to find where the causes of disease originate and where the "cure" comes from and what methods are necessary for the removal of the condition revealed' (Jensen, 1952).

Iridology then is stated to be the science of symbology which actually records itself in the iris fibres. The theory goes further than this and it is suggested that eczema or a rash is similarly only a symbol of the real cause from some internal part of the body which is not ordinarily recognised but is revealed in the iris.

The practice of iridology in Australia

The Committee found that putting a question such as 'Do you make use of iris diagnosis?' to an alternate health practitioner elicited one of three quite definite answers which correlated quite remarkably with the area of interest, and even professional affiliation of the respondent.

Chiropractors who are of the 'straight' school and usually members of the Australian Chiropractors' Association invariably eschew iris diagnosis as either irrelevant, of no value to them, or nonsense. Their answer was quite predictable.

Chiropractors of the 'mixer' category (those the Committee spoke to were often members of the United Chiropractors' Association) usually were equivocal on iridology. It might be used by some as a help to examinations of other kinds, others found no use for it, few regarded it as a major diagnostic method.

The third group or practitioners, the naturopaths, are usually keen on iridology. Some set great store upon it and one practitioner claimed a collection of some 40,000 iris photographs and great competence in using the method. Some believed implicitly in the published works on iridology, others thought that as so much had been published there must be 'something in it'. Yet other naturopaths were somewhat sceptical because it was difficult to see a basis for iridology and were genuinely anxious to get the method evaluated.

Is there a scientific basis for iridology?

The published work on iridology is extensive, some in German, much in English; some written for the modern cultists, much for naturopaths. The method is simple. One observes the iris with the naked eye or with the aid of a stamp collector's illuminated magnifier and can fill in details on iris zone maps which are printed in books or on separate sheets. Figure 1 shows a typical iris diagnostic chart.

Figure 1: A diagnostic chart for iris diagnosis

Colour photographs can be taken without difficulty using a 35 mm camera with close-up attachments and flat illumination from a ring-flash tube. The Committee encountered no claims that the photography or colour rendering was critical except that focusing should be sharp and the general technique good.

None of the practitioners with whom we discussed iris diagnosis seemed to denigrate photographs on unreasonable grounds.

The difficulty to the scientific observer comes in accepting the theory that the state of the body can be represented in the iris. The iris anatomically has no structure which is suitable for a visual display or indication. There is no known mechanism by which any organ can transmit its normality or otherwise to another point in the body and which would be expected to produce changes in the appearance of the, iris except in the most general way. The diameter of the pupil for example is a useful indicator of a number of biochemical changes of a general nature but since it can only dilate or constrict, the information conferred by this alone is of limited value.

There is certainly no known way in which body organs could be represented at specific locations in the iris.

The interpretation of iris appearance is not particularly difficult once the assumption is made that iridology is valid. One can therefore see the 'lesions' the iridology expert points out without any particular training although one would clearly require considerable experience to recognise them and name them.

Where there is particular disagreement is in the way iris signs are related to the body and its organs. This may be due to a different method of describing sickness between practitioners of different kinds.

In Jensen's book, for example, a series of colour plates are reproduced and interpretations are given but the terms do not have a generally acceptable meaning. One iris, for example, shows 'inherently weak pelvis and groin', 'chronic toxic settlement upper abdomen and diaphragm', 'lack of bowel tone from chronic toxic settlement, preventing elimination of waste', 'inherently weak gallbladder', etc.

The traditional iridologist does not state asthma, diabetes, epilepsy as a diagnosis but regards these, we are led to understand, as further symbols or collections of symbols from other organs.

In Australia, the Committee found a much more positive approach and there are naturopaths who believe they are capable of naming well-defined disorders. Furthermore, they are anxious and willing to participate in an evaluation of this ability. The Committee was impressed with this attitude and would have liked to have been able to evaluate iris diagnosis. (This problem is discussed in Chapter 7.)

According to its practitioners the iris is divided into about forty zones which run clockwise in one eye and anticlockwise in the other. Each zone represents a portion of the body and reflects illness and specific pathology in the corresponding organs and systems. This may be by colour variation and/or increase in localised density. As the disease entity proceeds to cure so do these localised changes diminish. Many of the changes are described in broad and vague language such as catarrh or scurf and other similar terms. A chart used by Australian naturopaths is shown in Figure 2. Experienced iris diagnosticians in Australia claim to be able to localise the organ or system involved as well as the specific pathology such as angina pectoris, aneurism of the aorta, kidney stones, diverticulitis or the various segments of the colon, etc.. More recent texts which are considered authoritative by iris diagnosticians are Deck (1965) and Jensen (1952).

For the present, iridology must be regarded as unacceptable as a diagnostic method and its present use is unwarranted until its possible worth can be assessed.

Kirlian Photography

A number of naturopaths and homoeopaths put forward the view that a supra-scientific explanation must be sought to explain the alleged success of homoeopathic remedies and other modalities used by naturopaths. It has been suggested that the explanation may be due to radioactivity, or some as yet unexplored emanation or force. A belief in radiesthesia was evinced by some practitioners, and this is said to be an aura surrounding persons and living things capable of detection by various simple devices such as a ring suspended by a thread which oscillates in such circumstances.

Naturopaths in general appear to welcome and espouse any fringe area of science that can be used to support their beliefs. The Committee has been told many times of an 'aura of radiation' around the body. This has been related to the phenomenon of Kirlian photography. In fact some appear to regard Kirlian photography as evidence that eventually mysteries will be revealed.

Since the time of Nikolai Tesla (1856-1943), it has been recognised that a corona discharge can be produced around conducting and semi-conducting objects. It is this phenomenon that has come into prominence since the publication by Kirlian and Kirlian (1961) of the spectacular form of the corona when recorded on colour film. The form of the halo of colours around a conducting object carrying a high-voltage high-frequency electric charge may depend on small differences in conductivity and surface shape. A fresh leaf gives a clear and brilliant corona, whereas after some days the display is less impressive.. Scientifically, such results might be explained by differences in the electrolyte content and conductivity of the plant cells as the leaf dies.

The Committee sought the advice of Associate Professor R.B. Makinson, Associate Professor of Physics at Macquarie University, since he and his colleague, Mr G. Kennedy, have had some experience with the technique of Kirlian photography. He states: 'The phenomena involved are: corona discharge and the photographic process. Both are rather complex things. It has been a happy hunting ground for spiritualists and quacks. Serious uses, e.g., in showing plant structure, might also emerge'.

The "terms of reference of the Committee of Inquiry did not include acupuncture, and the Minister indicated to the Chairman that this was a deliberate omission, since a separate committee had been enquiring into this subject. However, the present Committee found that many naturopaths were using this procedure, and that its use seemed to be on the increase. In January, 1977, the Acupuncture Specialists Practitioners Association had 98 members, mainly in New South Wales, and the President of that association, Mr R. Zindler, informed the Committee that it was his belief that in a few years acupuncture would become the dominant modality of the natural therapies. In view of this, acupuncture is dealt with briefly in this Report.

The Committee had access to the National Health and Medical Research Council Report on Acupuncture (1974), prepared by a team of three senior medical men who visited China late in 1973. It also had the benefit of a long discussion with one of the members of that team, Dr M.J.S. Sainsbury, Director of the Institute of Psychiatry in New South Wales. The Report gave qualified support to the conduct of clinical trials of acupuncture in Australia, not so much for anaesthesia (except in dentistry and obstetrics), as for alleviation of pain in such conditions as headache, sciatica, and joint pain, and the treatment of narcotic and alcohol withdrawal states and deafness. It recommended that initially the practice of acupuncture should be restricted to registered medical and dental practitioners, although if the trials were successful, acupuncture might be undertaken by nursing and other paramedical personnel working under direct medical supervision.

It is clear that Chinese practitioners of acupuncture undergo many years of rigorous training, perhaps of a rather empirical character. The non-medical acupuncturists in Australia have usually had a training of variable length and standard, but often very short, either in Sydney or Hong Kong. In these courses they acquire a facile knowledge of the theory and history of Chinese acupuncture, but little real clinical training by exposure to good practitioners of long experience. They are often extremely deficient in knowledge of the potential hazards of the procedure, such as damage to major nerves which are near some acupuncture points, or cross-infection due to the use of unsterilized needles. At least one coroner has drawn attention to the danger of contaminated acupuncture needles, following a death from hepatitis ('The Age', Thursday, August 24th, 1976).

The popularity of acupuncture among naturopaths and their patients seems to indicate that it is tending to become a cult, rather than a therapeutic procedure which may sometimes be useful as an adjunct to orthodox medical treatment. This trend may discourage the rational investigation of acupuncture which ought to be taking place, as recommended by the National Health and Medical Research Council investigating committee. The recommendations in the N.H.M.R.C. Report cited above seem to the Committee of Inquiry to be reasonable ones, which ought to be supported by the Australian Government. At the same time, the use of acupuncture by poorly trained naturopaths should be strongly discouraged.

RECOMMENDATIONS ON NATUROPATHY

1. The Committee does not recommend licensing of naturopaths as a vocational group as it considers that such licensing may give a form of official imprimatur to practices which the Committee considers to be unscientific and, at the best, of marginal efficacy. It appreciates that some control is desirable over persons practising naturopathy for fee or reward to protect the general public and it considers that vigilance should be exercised over this group by competent authorities to define the standards of premises from which practice is carried out, to control advertising, to police existing legislation prohibiting the treatment of certain diseases by other than medical practitioners and to restrict the prescribing of dietary advice.
2. The Committee recommends that action should be taken to license. acupuncturists, since this modality is reported to be on the increase, is a clearly defined technique for which standards of assessment can be laid down and presents a potential health hazard to the patient.

REFERENCES

British Herbal Pharmacopoeia (1972). (British Herbal Medical Association:London).

Chancellor, P.M. (1971). Handbook of the Bach Flower Remedies (The C.W. Daniel Co. Ltd: London).

Chapman, J.B. (1973). Dr Schuessler's Biochemistry: A Medical Book for the Home (New Era Laboratories Ltd: London).

Deck, J. (1965). The Fundamental Principles of Iris Diagnosis anstitut fur Grundlagenforschung der Irisdiagnostik: Ettlingen bei Karlsruhe).

Inglis, B. (1964). Fringe Medicine (Faber and Faber: London).

Jensen, B. (1952). The Science and Practice of Iridology (Bernard Jensen: Escondido, California).

Kirlian and Kirlian (1961). 'Corona Discharge Photography' J. Sci. Appl. Photog. 6, Issue 6.

Liljequist, N. (1893). Diagnosis from the Eye.

McLeod, J.G., Sainsbury, M.J.S. and Joseph, D. (1974). Acupuncture: A Report to the National Health and Medical Research Council.

Queensland: The Medical Acts, 1939-1966.

United Kingdom: Medicines Act, 1968.

von Peczely, I. (1866). Discovery in the Realm of Nature and Art of Healing (Druckerei der Kgl Ungarischen Staadtsdruckerei: Budapest).

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Source: Webb EC and others. Report of the Committee of Inquiry into Chiropractic, Osteopathy, Homeopathy, and Naturopathy. Canberra: Australian Government Publishing Service, April 1977.