I only recently began contributing to SBM, bringing not any particular expertise or scholarship but rather the perspective of a student. My goal in blogging is not to focus on issues specific to my school, of which I am quite fond and proud in general. Instead I hope to use my experiences, which SBM editors and readers tell me are not unique, to illustrate how CAM can interact with medical education. When writing, I constantly remind myself, “Everything you know about homeopathy and naturopathy was heavily influenced by the SBM docs, so try not to parrot their arguments lest you look like a brainwashed fanboy. Focus on relaying your experiences and trust readers to reach their own conclusions.” As a result, some have called my critiques a bit mild, but I can accept blandness to avoid seeming arrogant beyond my qualifications.

I was surprised, therefore, to be told by leaders of a campus CAM group that my most recent SBM post was full of personal attacks.They advised me to remove the post or at least whitewash it of names and links that identify the naturopath PB. They told me that the naturopath was upset and felt that my post misrepresented him. (Neither I nor anyone at SBM has been contacted by him yet, so I am taking their word that he was upset.)

Here is a sense of our back-and-forth as they tried to cajole me:

Me: My criticism focused on my experiences, relying on notes I took during his lecture and information on his website. Any corrections, clarifications, or other responses from him are more than welcome, either by email or posted as comments on SBM.

Them: Consider the naturopath’s need to manage his reputation online, which is an issue for physicians as well. Potential patients may be scared off by your post.

Me: I described his beliefs and practices as I was led to understand them from his own words. He is welcome to respond in this or another public forum.

Them: We need to apologize to the naturopath, and we will probably be unable to convince him to speak again. How will our lecture series survive if guests are afraid of being attacked online?

Me: Why should you apologize for some jerk who attended an open lecture? I am not affiliated with any of the groups that sponsored the lecture, nor do I represent our school when I blog. Anyone who promotes a controversial practice at a university should be comfortable dealing with criticism.

Visibly uncomfortable with this next step, they told me that if I did not cooperate they would feel forced to bring the issue to a school administrator. They assured me that they had no desire to see me disciplined, but they felt this was an issue of professionalism that needed to be addressed somehow. A bit shocked, I promised to think about their concerns, solicit advice from neutral faculty, and make a decision the following week.

Please, read my previous post and tell me what you think. I am open to negative feedback. While considering the appropriateness of my critique, however, remember that its subject is not simply a nutritional counselor who does cosmetic acupuncture; PB is a leader of a political lobbying effort to license naturopaths as primary care physicians. I believe that this activity makes his description of naturopathy more than fair game for public criticism. If I failed to understand him after listening to his lecture, then he is invited to clarify his arguments in the comments section, where any concerned patient could see. Such discourse and debate is encouraged on this website.

Back to the story: They emailed me five days later, warning that the situation had become more serious and that they would have to go to the administrator tomorrow if I did not self-censor. I replied with my conclusion that my post was reasonable, particularly in light of the lobbying. I welcomed responses in the blog comment section, and I promised to make appropriate corrections if any specific statements were identified as false or malicious. Their response was vague and hinted at possible consequences beyond their control.

After speaking with the administrator, they emailed me that he was waiting to hear back from university lawyers about whether my post could be considered libel or defamation. Hopefully not, they said, in which case it would just be a “matter of professionalism” to be handled on campus. Again I was advised, for my own sake, to remove the post at least temporarily. Again I was told that my critique veered into unacceptable personal attacks. No examples were given.

My family and friends were on edge with me…but the story just fizzles out. The administrator seems uninterested in regulating my speech, and neither he nor any other faculty member has told me I was inappropriate. The naturopath may still be upset, but I have not been contacted by him as of today, which is two weeks after I was first approached and one week after I emailed that I would modify the post in response to specific feedback. I have heard nothing from the naturopath except vague reports secondhand. The SBM editors, also responsible for the post, have not been contacted either.

Based on what I was told, I wonder if the naturopath pressured my classmates to lean on me. Their veiled threats surprised me, because they had been good sports in the face of my previous writing, even inviting me to attend events and ask challenging questions. I speculate that he told them something like, “forget about getting local naturopaths to speak for you if you don’t deal with this post.” This is merely my guess from their words and behavior. On the other hand, perhaps the naturopath doesn’t actually care as much as I was led to believe; presumably he would email me or the site editors if he did.

What can other students learn from my experience, which I am told by SBM veterans is not unique? Do not be afraid, but do be prepared. First, find allies among faculty as early as possible. I didn’t mention it earlier, but I acted proactively by visiting the administrator myself before the other students did, which enabled me to present my framing first (free speech, scientific standards) and gauge how he might react to their complaints. I chose a few other influential faculty and sent them my post; the more positive responses I got, the more confident I became that I would have local supporters if a credible threat materialized. Second, if you write publicly, be familiar with how to write opinion critiques in a way that is not defamatory. I was not exactly accused of libel, but it was hinted at, and I felt much more secure after getting advice from friend and family lawyers. In the event of an actual lawsuit, the SBM docs know organizations that help students or bloggers threatened with speech suppression. Third, when you are in the right, hold true to your principles! Apparently sometimes complaints will be nothing more than groundless bullying. A community like SBM can be a great source of strength.

I do not tell this story for retaliation or in defensiveness, but simply to show that I will not be cowed by unreasonable demands. I am of course still willing to hear complaints or corrections, and I will respond appropriately; I have no desire to be malicious or misleading. I have a great desire, however, to discuss and debate ideas relevent to the practice of medicine, and in that spirit I welcome anyone who would refute me with persuasive arguments.

To the editors and staff of SBM: I thank each of you very much for your advice, support, and patience over the past two weeks.



Posted by Tim Kreider

a med student blogging about integrative medicine on campus