Daniel GRUNWALD

FRANCE

Daniel GRUNWALD

– Physician, Secretary General Emeritus of the Conseil National de l’Ordre des Médecins (National Council of the Order of Doctors)
– Member of the Steering Committee of MIVILUDES (Mission Interministérielle de Vigilance et de Lutte contre les Dérives Sectaires – Interministerial Mission for Monitoring and Combating Sectarian Deviations)

The Order of French Doctors faced with cults and their relationship with unproven medical practices

A fact in modern society, a worrying indication of the uncertainty of the modern world, cults are infiltrating
all levels of our society. The medical world is no exception:

• The increasingly wide spread of these sectarian “health” movements and their different therapy procedures.
• Their advertising, exposure and even commonplace presence in the media.
• Their propagation even in healthcare circles, unsettling some doctors and other healthcare professionals

raise a great many questions.

In France, the Medical Council, a private body made up of practitioners elected by all their colleagues, is assigned by the State to perform public services with administrative and legal functions, with regard to practicing doctors.

This is why, over the course of the past few years, the French Medical Council has been led to look into complex reports of Cults and Medical Practices.

Different developments over the years in the activity of sectarian movements has led us more and more to integrate these reports into an overall general framework of the increasingly complicated overlaps between “sectarian deviations” and “Health” in the widest sense of the word.

Our position is therefore initially to concentrate on developments in events as seen in harmful sectarian health practices, before going on to look at the position taken by the Medical Council on this subject.

THE FACTS

 

1. SECTARIAN DEVIATIONS BRANCHING OUT INTO THE FIELD OF HEALTHCARE

Observations made over the course of many years clearly reveal various developments in harmful sectarian deviations in the healthcare field.

 

• Diversification in sectarian activities

  The approach to the concept of cults has benefited France with various lines of research, several parliamentary reports, the creation of a watchdog and an Interministerial Mission for the Fight against Cults, and more recently the implementation of an “Interministerial Mission for Vigilance and the Fight against Sectarian Deviations” (November 2002).

  • We have to be aware of the problematic nature of defining and pinpointing sectarian deviations. The important thing for us to concern ourselves with is to identify and highlight structures based on separate ideologies, looking at the harm they do to individuals, restricting their physical or mental integrity. This is a “compartmental” approach centred around revealing the characteristic damage caused by “harmful sectarian deviations”.

   

  • Health-related themes have always played a part in many cult families, which leads us to pick out healing cults, or psychoanalytical movements, whose activities are often performed using “front companies”, such as treatment centres which do not, on face value, appear to be any cause for concern.
  • General growth trends seen in taking over a person’shealthcare in the certain harmful cults can be grouped around different themes :
    • a strong development in sectarian activity based on taking charge of so-called “psychotherapy”
    • an increase in activities based on techniques taken from modified “Orientalist” ideas.
    • The development of action centred on irrational ideas on an individual’s personal development.
    • The infiltration of professional training front companies affecting healthcare professionals,
    • The infiltration of humanitarian movements by cults with their claims of being associations helping the sick or bringing aid to disaster victims.

  These are perfect examples of how cults are seeking to act in all fields of healthcare provision.

  They also show a much more general thematic in the development of sectarian activities in health.

  • While some of these activities are still concentrated on treating illnesses and problems labelled as such,
  • an increasing number of others are developing across wider areas, not only in the upkeep, but also in the development of health, well-being, physical and mental ability, personal empowerment through esoteric ideologies – pseudo-cosmological and pseudo-religious in nature.

  More and more of these branches of health-related sectarian deviations are clearly and voluntarily complicating the very concepts of “health” and “sickness”, changing the way their followers look at the link between the individual and their “health” or their “sickness”.

  This is also without forgetting the influential international aspects of cults increasingly seeking to justify collaboration with the various countries connected with the issue of cults.

 

• Developments in sectarian structures
  • the activities of the big national and international “traditional” sectarian groups persist, and even in some cases are becoming more radicalised.
  • Added to these are the increasing number of small groups that develop around an “accompanying-therapist-guru”, sometimes acting in isolation (but often with paid “training” given by a central body).

This is how we differentiate sectarian groups to a great extent nowadays – the truly “traditional” cults and smaller, separate groups, even very small groups. These are more widespread. We are seeing more and more of them and they are also more difficult to approach.
As regards their links with health and medical practices, this is a convenient distinction for us to make, as it enables us to better determine the extremely varied set of issues raised by sectarian movements and also to stress what we must obviously avoid in all of this: each cult movement is separate from all the others, leading us to pose specific questions. To widen their influence, a lot of sectarian movements are seeking to use medicines and sometimes healthcare professionals. These intrusions into the medical sphere vary in accordance with the underlying aims of the cults.

 

• THE USE OF “MEDICINES”

 

Two trends exemplify the relationship between cult practices and medicine: Firstly, criticism of and opposition to “modern, official” medicine, particularly on the part of “therapy” sectarian movements lie in a competitive relationship with “Western” medicine. Secondly and concurrently is the use of procedures and therapies labelled as “medicine”, “unofficial” and originating in old traditions and mysticism, coming from ancient cultures or on an esoteric basis.

We can categorise a lot of so-called “soft parallel, alternative, complementary, non-conventional” medicine in this vein, although we prefer to call these “unproven medical practices“. Indeed, the common denominator in all these practices is the absence of any authentic, recognised scientific validation, and the absence of any evaluation. The field of application of these “unproven medical practices” is itself very large and patternless, ranging from medicines that have become widely accepted, to totally irrational and esoteric localised practices. The “medicines” behind these sectarian ideologies are more likely to come from the most obscure extremes of esoteric therapeutic theory, but can also sometimes arise from activities based on modified scientific ideas,
or proven therapies that have been changed and adapted (see, for example, the many derivatives of dietetics).

Identifying such overlapping sectarian activities and “unproven” medicines is not easy, because of the similarities of form and presentation, which should not obscure the fundamental differences – particularly their results:

Broadly (and historically), “unproven medicines” and sectarian practices do appear to present various differences:

• Unconventional medicines solely aim to treat illnesses, or problems labelled as such. They are prescribed by “therapists”, with no other stated goals;
• this contrasts with harmful cults, and concern people who are not necessarily ill, but rather have difficulty making themselves heard, demanding “attention”, who receive a rapidly coercive ideology, breaking off their social links and entering into a group with a hierarchy revolving around a guru. They advocate well-being more than health, with pseudo-religious or pseudo-cosmological ends.

But the reality is, in fact, much less straightforward than this. We can find cults solely positioning themselves under the guise of “medicine”, using the trust that is unconsciously levelled at this concept, each with the new structure of having limited size cults. This coincides with the trend of some therapists using unproven medicines to train groups of patients, seeking not only to treat illnesses, but also to bring them back to a state of health and well-being !.. This is how the situation stands at present.
These different facts lead us to believe that that the distinction between unproven medicines and the practices of cults must obviously play a part in our studies, avoiding any mixture of the two concepts, and seeking to detail each situation – particularly the nature and degree of any “harmful” practice for individual patients. But we must also recognise that these untypical “medicines” can hide harmful sectarian intentions.
Obviously, not all unproven medicines are connected with cults, but cult movements are keen to present themselves in a medical light.
We can point top the fact that it is often the same type of patient, and even the same kind of healthcare professional that is tempted by esoteric medicine provided by sectarian groups. Although we would not like to obscure the often considerable charlatanism and financial greed present in these “healers”.

 

1. THE PARTIES INVOLVED IN HEALTH-RELATED SECTARIAN DEVIATIONS

   Shapeless cults and the use of “medicines” – this leads us to see a third aspect to the situation: the participants in these sectarian activities – including those in the healthcare sector. This is what justifies the intervention of the Medical Council.

   • The big players carrying out “therapeutic” activities for many sectarian groups, are mainly “inspired converts”, self taught and self-proclaimed. Their practices are sometimes deemed illegal in the medical world (such as with a diagnosis preceding the therapy applied).
     The use of these converts with self-proclaimed titles amounts to an illegitimate use of authentic professional titles, and even to the creation of new, unfounded titles with no relation to healthcare, deceiving people into gaining their confidence.

    

   • Doctors and other healthcare professionals.

     In some regrettable and memorable case doctors have been accused of participating – actively participating in some cases – in the activities of sectarian movements. This is a difficult subject, because aside from the specific cases that have already been documented and acted upon, there are many allegations and rumours put forward in a highly emotive atmosphere which gets in the way of objective analysis. There is, of course, no question of our getting involved in the freedom of opinion or belief of all individuals, including doctors. Rather, we only aim to target any harmful interference with patients through the practice of medicine and the reprehensible activities of cults.
     GPs, who may be of fragile character and feeling a certain sense of powerlessness in the face of misery and death, could be seduced by the conviviality of a “study” group before being sounded out be a cult – and we know how much some cults seek the participation (and support) of doctors.
     In some cases, unfortunately, a doctor, drawn into the cult, becomes active, using his position to attract new followers into the cult: a sympathising doctor who goes on to canvass his patients – consultant doctors for some cults to confirm the legitimacy of their esoteric “treatments” on offer. Fortunately, this does not happen very often, but there have been some examples. Furthermore, we must emphasise the fact that through a lack of information (and critical instincts), many doctors leave themselves open to abuse by advertisements for pseudo-scientific treatments distributed by cults, and therefore run the risk of becoming followers themselves, without knowing it…at least at first. Because the continuation of these practices,like any act of “canvassing” for cults by doctors, generally involves the active participation of the doctor, either in the context of a “healing” movement, or on an individual basis.
     In these situations, the precise methodology of the GPs in their prescriptions and their justifications should be detailed. Some unproven medicines, with no confirmed sectarian influence, are used as follows: prescribed to replace scientifically proven treatments, or in a purely fraudulent manner, sometimes creating imaginary illnesses – truly reprehensible; different situations in which these unconventional, unsystematic, non-hazardous medicines are used with discretion as a supplement to proven treatments in some cases, following detailed information from patients, and with no other goal than to give them the best suited treatment possible, including researching the placebo effect. On the other hand, the addition of actions or attitudes to these prescriptions originating in a cult will naturally lead us to believe that there is a possibility of abnormal, harmful takeovers of patients’ treatment – which are therefore blameable.

     These aspects are of particular concern to doctors, due to their position as prescribers and their own particular responsibilities. But the temptations of and recruitment by cults are of relevance to all healthcare professionals: dentists; paramedical professions, who are sometimes more vulnerable to irrational arguments. (some physiotherapists, midwives, nurses; also social workers, etc). These professions can also more easily influenced by techniques infiltrated by sectarian ideologies. We can cite the current problems posed by some movements developing training with sectarian connotations based around pregnancy and childbirth.

      

   • Patients

    

   Possible followers, to a greater or lesser extent, they deserve some attention with some points that should be raised in the face of a complex reality of a sociological nature:

   • Some psychological profiles or life situations make people more vulnerable to sectarian advertising or recruitment, just as some pathological circumstances do – a subject any forewarned GP must eventually broach with his patients. At the opposite scale of things, taking on individual patients who have just left cults is often difficult, requiring specialised advice and sometimes specialised care.
   • The family and friends of patients are often involved. They often bear witness (powerless or appalled) to the damage done by a cult to their friend or family member. These people are sometimes also canvassed by some groups.
   • But these patients (and sometimes also their families!) can also be the ones requesting this “miracle” treatment they heard about through advertising or by “word of mouth”!
   • There are so many situations complicating the doctor-patient relationship requiring explicit, repeated information on the part of the family doctors. On top of this, some beliefs or leanings held by the patient or their family may even stir up greater problems. With this in mind, we immediately think of the highly specific line of questioning sparked off by some adult patients refusing any blood transfusions, even faced with absolute, immediately life-threatening indications.

THE OPINIONS OF THE MEDICAL COUNCIL

Even limiting ourselves to the connections between sectarian activities and the take-over of healthcare provision, the field for study is still very large, and the source of many questions and a lot of very difficult practices.
“Recognise-Understand-Act” sums up the attitude of a professional body required to rule on healthcare practices perverted by sectarian influences.

 

1. ANALYSIS OF PAST SITUATIONS

   The analysis of sectarian movements, their developments, their ever more complex links with health and, sometimes, with medical practices, is fundamental. Analyses are made as a result of information or complaints received from patients, their families and various relevant public bodies in the fight against harmful sectarian movements.

   This step has to take into account all the problems that must be overcome: the changing face of sectarian movements and their variability over time, the emotive overtones surrounding information supplied by victims or their families, the need to solely consider sufficiently backed up facts; a clear distinction must also be made between the medical activities of a doctor and his opinions – something that is not always so easy to achieve. Because even though, the use of the title of “doctor” is sometimes used as support for reprehensible acts, and even for taking personal positions on issues, a doctor is still a “doctor” in the eyes of other people.

   As we have seen, an appraisal of the validity of certain medical practices and prescriptions may also prove difficult, as in this case we must view things from the patients’ perspective: Did they receive the level of care from their doctor that was needed and justified by their state of health? Was there any deception involved?
   Can we detect any harmful or dangerous attitudes and prescriptions? This is all with regard to GPs’ behaviour towards their patients, derailed from its proper course through sectarian control, as well as any chances they may take to use certain unproven medical practices.

    

2. JURISDICTIONAL APPROACHES

   These approaches can come into play at various levels:

   • The issue of criminal activities committed by cults in France, with the more serious cases being heard by the criminal and civil legal authorities.

    

   • The professional jurisdiction of the Medical Council is only called into action in cases concerning medical practices that do not adhere Code of Medical Ethics. A number of articles of this code of practice can be involved, depending on the case in hand. Doctors must at all times respect the principles of morality, probity and proper dedication to medical practice. Doctors must never depart from the proper attitude. They must be attentive and respectful towards the patient being examined. Furthermore, these provisions run alongside those detailed in Article 3 of the European Medical Ethics principles (as decreed by the Standing Committee of European Doctors) as detailed below: “doctors shall refrain from imposing their own personal, philosophical, moral or political opinions on patients during the course of carrying out their job”; Article 5 of the French Code of Medical Ethics rules that doctors “may not depart from their professional independence in any way whatsoever”.
     In practice, the rulings laid down by the disciplinary chambers of the Medical Council often concern a failure to respect Article 39 of the Ethical Code: “Doctors may not present any fraudulent, insufficiently proven remedy or procedure as being beneficial to health to any patient or their family. All fraudulent practices are forbidden”. Article 40 deals with dangerous therapeutic treatments as follows: “Doctors must refrain from carrying out examinations and actions prescribed as therapy which may make a patient run unnecessary risks”.
     The following cases are also covered: a doctor’s complicity in illegal medical practices; interference in family matters; a lack of respect for provisions put in place for the protection of minors, as well as anyone “incapable of protecting themselves due to their age or their physical or mental state…”, under which circumstances the doctor must “alert the legal, medical or governmental authorities…other than in exceptional circumstances”. These situations are specifically provided for in the French Code of Medical Ethics, which supplement the provisions of the Criminal Code.

    

   • The submission of a case before the professional courts may only supported facts deemed to run contrary to the ethical code liable to cause damage to patients.

    

   • A study of complaints submitted to ordinary jurisdictions regarding harmful medical practices inspired by sectarian deviations bring out two aspects for consideration:
     • complaints are uncommon, and rarely come from the victims themselves. More often, they arise from information brought to bear by their families and friends (which, if proven, can bring about the direct involvement of the Medical Council in cases concerning GPs).
     • they are generally not specific complaints, but are often worrying because of the relatively systematic nature of harmful practices put expounded in the ideology of the sectarian movement concerned. Once confirmed, the complaints dealt with become subject to disciplinary sanctions, most often through the temporary or permanent banning of the practice.
   • These situations can be compared to those in other healthcare professions with their own specific professional jurisdictions (dentists, midwives, pharmacists, physical therapists, etc).

    

3. INFORMATIONS FOR HEALTHCARE PROFESSIONALS

   These considerations explain the importance we attach to information for doctors (and all other healthcare professionals) on the reality of cults and risks associated to the deviations these cults cause:

    

   • general information in the form of articles included in the National Medical Council newsletter,
     sent to all general practitioners.

    

   • Targeted information about individual cases – particularly with regard to unproven reported events, or “rumours” which merit further enquiries, enabling GPs to be kept up to date and warned. The preventive effects are often very positive.

   Generally speaking, talking about the reality of cults and their relationship with certain advertisements for unverified healthcare methods is undeniably beneficial. We can see that doctors are now much better informed about the risks related to the intrusion of sectarian practices in the provision of healthcare.

    

4. PARTICIPATION IN ACTIONS UNDERTAKEN BY THE PUBLIC AUTHORITIES
   • In the context of its assignments, the Medical Council is regularly called upon for advice by the Health Minister. It is represented within the steering committees of interministerial groups devoted to sectarian phenomena: The “Interministerial Mission in the Campaign against Sects” followed by the “Interministerial Mission for Vigilance and the Fight against Cult Deviations” (MIVILUDES) following its creation at the beginning of 2003. These bodies gather crucially together representatives from the various authorities, associations and structures concerned.
   • On 12/06/2001, the French Parliament voted for a law “to strengthen the prevention and repression of sectarian movements which restrict human rights and basic liberties“. Amongst other things, this document can be applied to sectarian deviations in the healthcare sector, with its aim of amongst other things: “dismantling any legal entity…which carries out activities with the aim of, or having the effect of, creating…the psychological or physical subjection of people taking part in such activities…” (art. 1); the extension of criminal responsibility to legal entities with regard to certain infractions (chap II); measures limiting the advertisement of sectarian movements (chap IV); and more particularly, in the matter at hand, Chapter V – provisions relating to the fraudulent abuse of ignorance and weakness, “either of a minor or of any person who is in a particularly vulnerable position because of their age, illness, poor health, or who has a physical or mental deficiency, or who is visibly pregnant (with the patient knowing she is pregnant), or a person in a state of psychological or physical subjection as a result of serious or sustained pressure, or of techniques designed to alter their judgement in order to lead this minor or this person into a specific act or abstention, and which are seriously damaging.
   • In its recently published 2003 annual report, MIVILUDES made an in-depth study of the concept of
     “sectarian deviations” and made a number of proposals about health, among other aspects:
   • the desire to see the situations of victims of abuse and weakness and their psychological and physical subjection be properly (and more readily) taken into account;
   • a proposal for the overall management of health and the healthcare professions to publicise recommendations for good healthcare practice;
   • A wider distribution of the regulatory provisions regarding obligatory vaccinations, as well as information concerning the refusal of blood transfusions.

    

5. INDIVIDUAL LINES OF QUESTIONING

 

A certain number of specific problems remain in the wide subject of the relationship between health and sectarian organisations.

 

• Titles in healthcare professions:
  With regard to the various “healthcare professions”, we must recognise that while professions have clearly-defined, regulated job titles and names solely able to be used by professionals with a recognised proof of quality of training and titles, a whole group of “professionals” exists on the fringes. Their qualifications and fields of expertise range from perfectly honourable, recognised and useful situations, through to individuals holding titles with no supporting evidence or origin. Patients consulting these people are confronted with confused and false guarantees, which are often consciously upheld within harmful, sectarian establishments. It would appear desirable that a clarification of ambiguous titles would bring about better information for the public.

 

• Deceptive advertising:
  Deception is used in some advertisements singing the praises of “miracle treatments”, using pseudo-scientific reasoning, misleading in nature.

 

• The refusal of healthcare in connection with sectarian ideologies: the example of vaccinations:
  With their refusal of “official, scientific” medicine, some cults readily use the policy of refusing to undergo obligatory vaccinations whose effectiveness is, however, confirmed. This leads some followers of sectarian movements to request unjustified vaccination contraindication certificates. Some General Practitioners go along with this, drawing up “non-obligation” certificates, which are punished when such cases are revealed. In contrast to this, doctors are requested in these cases to inform their patients of the importance of respecting the schedule of vaccinations offered, in order to obtain their consent for carrying out these preventive measures.
• The specific case of the refusal of blood transfusions:
  This issue has been highlighted in recent years through various cases of people refusing the injection of blood products, even when such a refusal led to certain and immediate life-threatening indications of the patient concerned. This lack of consent was sustained in spite of the efforts made by doctors to convince patients to accept the essential, urgent treatment.
  When this treatment concerns adults (the situation with minors can be settled through specific legal provisions), the dilemma faced by the doctor consists of reconciling two legally-imposed requirements: on the one hand, respect for the patient’s wishes, while on the other hand, doctors must perform or order treatment essential to the patient’s survival. There is an obligation to help to any person whose life is in danger. Recent case history confirms the legal foundation of this dilemma, as well as the obligation to respect patients’ wishes. Only in extreme life-threatening situations does the law allow the possibility of carrying out essential actions for the patients’ survival, in spite of their initial lack of consent.
  Such situations can also relieve the family and friends of the patient concerned of their responsibility, when they actively intervene not to grant their consent to the treatment offered.

* * *

The intrusion of harmful sectarian deviations in the field of healthcare is now as disconcerting as it is ever-increasingly insidious. It has an influence on both the progress and the uncertainties of our modern world. Along with many other sociological considerations, two “health” aspects currently exist in tandem:

• New possibilities in healthcare, inconceivable only a few years ago, have brought about undeniable progress through scientific developments in treatment and prevention in Public Health and Education to which doctors are obliged to subscribe.
• But these noble aims, distorted in some quarters through dubious advertising practices, also sometimes bring about pure fantasy in research performed into truly artificial senses of well-being, physical and mental bliss and personal empowerment, which sectarian movements put to full use, along with “unconventional and unproven” medicines.

We see it as being ever more essential to guard against the take-over of healthcare by sectarian activities – which constitute a rising threat in modern society. To do this, we need to spread information as widely as possible among people who may come up against these activities.

Marseilles, March 27-28 2004