Part 1 The US National Institutes of Health
Many people concerned with the rights of North America’s original peoples are aware of the heinous history of colonialism and the abuses perpetrated by boarding schools (and racist education in general), church indoctrination and subjugation, social services that break up families, military genocide, land-theft, and a “health-care” system once sanctioned to sterilize Native women and inflict disease. There is also an aspect of 20th and 21st Century health care policy that represents a new assault on culture; though the public is generally unaware of it. And that is the state attempt to regulate and control Native American healing practices.
I first became concerned with this issue in 1993, a year after the newly formed Office of Alternative Medicine (OAM) was established as a branch of the US National Institutes of Health. Wayne Jonas, MD (who two years later became the Director of the OAM) organized the Shenandoah Healing Exploration Meeting near Washington DC to inform NIH officials and health care providers about complementary medicine modalities, research issues, and ethical concerns. I was there to speak about Native American Healing traditions. I was probably chosen because I was one of the few lecturing about indigenous medicine in medical schools and spoke a language that bridged indigenous science and conventional biomedicine. (I want to make it clear that I did not seek this role and in later years deferred to Native colleagues and elders whenever appropriate. Note 1)
Through a combination of presentations at the Shenandoah Meeting, letters sent to the NIH and Congress—either directly or forwarded by the Council for Healing See Note 2, I influenced the NIH to remove the category of “Native American Medicine” from the listing of Complementary and Alternative Medicine modalities on their website. It remains my contention that state and federal licensing boards (generally white male) should have no say in defining the scope of indigenous healing, the qualification of practitioners, or the type of evidence that establishes credibility. Such a regulatory board becomes all the more absurd as one realizes that western biomedicine and indigenous medicine have very different definitions of health and consequently different ways to enhance or restore it. Note 3 And because indigenous healing practices are spiritual in nature—some “interventions” even taking place during a Sweat Lodge, Sundance, or other ceremony, it is protected under the American Indian Freedom of Religion Act and the first and fourteenth amendments of the U.S. Constitution.
Individuals and organizations that pursue power, profit, and control don’t give up easily. In early 2013, a Colorado based social worker began lobbying legislators to create standardized education and licensure for Native American healers or those who wish to incorporate their methods when working with families. I met with the gentleman and expressed my opinion that governmental regulation violates indigenous concepts of accountability—which should be to Native communities and people rather than to government boards. Incorporating indigenous methods into social work could result in the absurd prosecution of unlicensed urban practitioners (tribally recognized medicine men and women) for infringing on protected professional turf. The social worker was unconvinced. I decided it might be best to be proactive by writing an article that deals with the indigenous licensure issue for a peer reviewed science journal. I wrote the piece within a week and sent a copy to colleagues at the Native American Rights Fund who thoroughly agreed with my stance. At that point I submitted the article to the Explore: The Journal of Science and Healing (Elsevier Publications), with a cover letter explaining the timeliness and urgency of publication. To my surprise, instead of the usual three to six months response time, the article was published in the next issue. Note 4
But a new threat was looming from a much larger and more influential organization.
Part 2 The World Health Organization
In 2013 the World Health Organization published a 76-page paper titled “WHO Traditional Medicine Strategy 2014-2023” The paper focuses on T&CM, Traditional and Complementary Medicine, with a strong emphasis on acupuncture as a representative example. The WHO defines Traditional Medicine as “the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health, as well as to prevent, diagnose, improve or treat physical and mental illnesses. It is used as a comprehensive term to refer both to traditional medicine systems such as Traditional Chinese Medicine (TCM), Ayurvedic medicine and Unani medicine, and to various forms of indigenous medicine being practised traditionally.”Note 5 This is a bizarre definition, blurring distinctions between the technologies found in unified healing systems such as TCM and the extraordinarily diverse spiritual/healing practices of both pre and post-colonial Original Peoples.
In order to improve the quality, efficacy, safety and availability of T&CM, the WHO advises member states to “determine their own national situations in relation to T&CM and then to develop and enforce policies, regulations and guidelines that reflect these realities.” (p12) Although the authors note briefly the importance of protecting “the intellectual property rights of indigenous peoples and local communities and their health care heritage” (p19), we must balance this statement against the general theme of regulation, evaluation, and integration of traditional healing systems into universal health coverage.
There are many things to be admired in this publication. The desire to improve public health is commendable as is the rational concern about risks associated with T&CM such as “use of poor quality, adulterated or counterfeit products; unqualified practitioners; misdiagnosis, delayed diagnosis, or failure to use effective conventional treatments; exposure to misleading or unreliable information; direct adverse events side effects or unwanted treatment interactions.” (p31)
Yet there are also some things very wrong with the WHO opinions. First and foremost is its implicit support of the authority and dominance of Western biomedicine and its cultural/conceptual framework.
I contend that with regard to North American First Peoples’ healing systems, the WHO ignores the history of colonial abuses and academic imperialism that lead to Western biomedicine’s imbalanced power. I read the report as a byproduct of both colonialism and paternalism.
Secondly, the WHO publication confuses complementary medical systems, such as Chinese medicine, with indigenous healing and implies that similar policies and regulations can be applied to both. Chinese medicine has been well integrated into health care in China. Unlike indigenous medicine it relies on a common theoretical base, one language (Chinese), one ethnicity (Han), and a literary tradition spanning thousands of years. It is thus easily standardized. Chinese Medicine is not considered a fundamentally religious activity, nor does it require a particular geography—a home base-- to be effective, the latter being the very definition of “indigenous”. To put Traditional Chinese Medicine, a complementary and alternative medical system, in the same regulatory framework as indigenous healing is a serious error. It probably reflects the weight of Chinese influence on the WHO document.
This influence can be traced to Margaret Chan, MD, Director General of the WHO from 2006-2017, who wrote the Foreword. Two of the five members of the drafting group were Chinese, including Q. Zhang Note 6, coordinator of the WHO’s Traditional and Complementary Medicine Programme. Q. Zhang was also responsible for the revision and editing of the document. Financial support for the development of the document was provided by the government of the People’s Republic of China. Additionally, “the government of Hong Kong SAR [Special Administrative Region), the People’s Republic of China and WHO Collaborating Center for Traditional Medicine in Hong Kong provided technical, financial and logistical support for the meetings of the three working groups, the development and the printing of the document.” (p.5)
I cannot help wondering if China’s policies and attitudes towards indigenous peoples helped shape the scope and recommendations of the WHO document. Consider these two strange contradictions. Firstly, although China recognizes 55 ethnic minority peoples, it does not recognize the term “indigenous peoples.” Secondly, China signed The United Nations Declaration on the Rights of Indigenous Peoples yet will not implement many of the provisions. As summarized by the IWGA (the International Work Group for Indigenous Affairs), China has forcibly relocated original peoples and virtually eliminated hunter-herder-nomadic lifestyles that had persisted through many thousands of years. Note 7 Why? To promote mining and property development, and in the case of the Evenki tribe to also create the Aoluguya Ethnic Reindeer Resort, a Disney-like theme park that displays, for Chinese tourists, the lifeways of a “backward” people.Note 8 In 1998, Qi Jingfu, former Minister of Agriculture stated, “It is the PRC’s national policy to end the nomadic way of life for all herdsmen by the end of the century.” Note 9
Whether driven by ignorance, nationalism or economics, China’s denial of indigenous rights and knowledge has reached beyond its borders. I cannot count the number of times I have argued with Chinese scholars to counter the Sinocentric and academically unsound notion that “America’s indigenous people came from China, which is why their healing traditions are similar.” I even met a Chinese doctor of TCM who claimed, “Mexico belongs to China; we settled Mexico first.” I am not trying to impugn or ascribe attitudes to the many dedicated physicians and scholars, Chinese or other, who work for the WHO and are sincerely trying to improve worldwide health and quality of living. I am only advising caution, especially when a member nation, not known for its protection of ethnic or environmental rights, may sway, manipulate, or control opinion.
The recommendations and tone of the WHO document would have been very different if it were written at least in part by the indigenous people it purports to regulate or represent.
What do I propose? I advise that governments promote the rights of indigenous nations to independent self-regulation. No non-indigenous organization, association or institution has the right to supervise, organize, standardize, legitimize, credentialize, or commodify indigenous healing practices.
1 For example, a few years after the Shenandoah Meeting, I was invited to conduct a Native American blessing ceremony in front of one of the NIH campus buildings “to honor America’s original healing tradition.” I declined and recommended Mohawk Chief Jake Swamp (1941-2010). I explained to the NIH official the role of the Haudenosaunee Confederacy (of which the Mohawk is a member nation) in the construction of the US Constitution and the symbolic importance of Chief Swamp’s Tree of Peace tree planting ceremonies. Chief Swamp accepted the invitation and conducted the ceremony.
2 I am a “Distinguished Advisor” to this healing research and patient advocacy group founded by noted author, researcher, and clinician Daniel Benor, MD
3 An example is the Cree concept of health, Miyo-pimatisiwin, which implies physical, psychological and spiritual balance; a healthy diet based on Cree traditional foods gathered, hunted, fished, or trapped in the wild; natural outdoor exercise; and being a good example of traditional ethics and values. Like the word “health”, the word “medicine” means something different in different contexts. Legislators may be worried about people practicing medicine without a license. But what they mean by “medicine” does not match the cultural meaning of “medicine” in North American indigenous traditions. Look up the word “medicine” in a Cree dictionary and you get maskihkiy, which means a healing gift or a spiritual power that confers benefits. A Lakota Medicine Man (Wicasa Wakan) is not a physician in the Western sense, but rather a Sacred (Wakan) Person (Wicasa), or we might interpret the term as a person who serves the Wakan (the Sacred). Would the WHO presume to exercise authority over joy, a medicine mentioned in the Bible? “A joyful heart is good medicine, but a crushed spirit dries up the bones.” Proverbs 17:22. Yet, different concepts of medicine do not preclude indigenous and allopathic practitioners from collaborating on patient care, as colleagues and equals.
4 “Native American Healing: A License to Practice?” Explore: The Journal of Science and Healing 9:4, July/August 2013, 203-205
5 Promoting Access to Medical Technologies and Innovation: Intersections between public health, intellectual property and trade. 2012 World Health Organization, World Intellectual Property Organization and World Trade Organization, p. 89
6 Dr. Zhang Qi, expert on TCM from China who has focused much of his career on combining TCM and western medicine. https://sites.google.com/site/whoictm/participants/zhangqi
8 Fraser, Richard “Forced Relocation Amongst the Reindeer-Evenki of Inner Mongolia” Inner Asia 12:2 (2010), pp. 317-346
9 Xinhua News Agency (official voice of the Chinese Communist Party), “Be It Ever So Humble” 21 August, 1998. Forced relocation and termination of the land-based lifestyle (a history familiar to America’s First Peoples) are a necessary first step in the creation of a decontextualized, de-spiritualized category of “indigenous medicine” as a subset of the Western concept of “medicine.” Evenki people say that reindeer are as important to them as rice is to Han Chinese. Without the reindeer they cannot live. An elderly Evenki woman remarks that living away from her original lands, “the shaman’s drum cannot travel into the sky… People no longer meet spirits because they are too far away from the forest.”(Fraser ibid. p. 327)