In this article, I convey the nature of credentials, define credentialism, describe pseudocredentialing and pseudocredentialism, summarize several relevant studies, report on a correspondence course I took recently, and list some suspicious characteristics of providers of alternative health education.

Credentials and "Credentials"

The healthcare marketplace is fraught with "credentials," some legitimate, some overrated, some dubious, and some far afield of science. A bona fide credential is any evidence that one is trustworthy or has authority. However, since authority does not guarantee trustworthiness, whether a credential deserves confidence depends ultimately on whether the tenets that underlie the credential are worthy of confidence. "Authority- type" healthcare credentials range from the science-based (e.g., podiatric [chiropodist, or "foot doctor"] licensure) to the controversial (e. g., naturopathic licensure).

Credentials encompass (1) achievements and (2) documents that attest achievements. Many consumers mistake documentary credentials for proof of skill. Often, they are merely proof of past enrollment in an academic program, not proof of erudition or skill. Educational credentials are the professional standard because academic standing is more quantifiable than knowledge or skill.

The most commanding educational credential, and therefore the most tempting to would-be misusers, is the doctorate. There are many types of doctorates, but all are categorizable as "traditional" (e.g., a nonhonorary Ph.D. degree), "professional" (e.g., an M.D. degree), and honorary (e.g., a D.Sc. degree without academic status). Some types of doctorates in each category are considerably more doubtful than others. For example, Bears' Guide to Earning College Degrees Non traditionally (1995) lists as controversial "professional degree titles": D.Hyp. (hypnotism), Graph.D. ("Graphoanalysis"), and H.M. D. or "M.D.(H.)" (homeopathy). Many such degrees are available throughout the United States.

Another Brick in the Wall

In 1994, I met a lawyer who told me he had been seeing a "doctor" for nutrition counseling. Because very few science-oriented physicians specialize in this, I asked the practitioner's name. The name was not that of a physician, nor even that of a legitimate Ph.D. or the like: The practitioner the lawyer had consulted was a "Doctor of Nutripathy" (D.N.). Nutripathy [see NF 4:57-61, 1987] is a theistic, vitalistic "religious science" that involves a variation of Bach flower therapy [see NF 12:26, 1995] and "biochemical analysis" of saliva and urine. I asked the lawyer if he would provide me with whatever printed material the "nutripath" had given him, and he sounded agreeable; but, later that year, he declined. The D.N.'s classified ad in the January/February 1995 issue of Newlife did not include the word "nutripath" or "nutripathy" but designated him a naturopath ("one who uses only safe, natural approaches"). On July 6,1995, I phoned his office as an ad respondent and asked the man who had answered the phone what was the source of the D.N.'s (alleged) naturopathy degree. The staffer replied:

Uh, I'm not exactly sure of that. I can tell you that he's a clinical nutritionist, okay? Which means that he-we look for causes of symptoms and then deal with it in a natural fashion. Where he- Where he practiced or where he went to school, I'm not exactly sure.

After I expressed skepticism, the staffer asked me to wait a second and said he would "check the wall." Finally, he responded: "The American College of Nutripathy" (ACN) [see NF 12:15, 1995]. Founded in 1976, ACN, a nonaccredited[*] correspondence school in Scottsdale, Arizona, is not a school of naturopathy; it has never offered degrees therein. However, according to the last three editions of Bears' Guide to Earning College Degrees Nontraditionally (1989-1990, 1992, and 1995), ACN does offer doctorates in nutripathy. Yet, in a questionnaire he completed for me in July 1994, nutripathy's founder, Gary A. Martin, indicated that ACN offered only nondegree certificates. A year later, on July 6, I called ACN for clarification. I asked to speak with Martin, but the woman who had answered the phone told me that Martin did not take "incoming calls." In any event, since 1989, the American College of Nutripathy has offered more than a dozen kinds of quasi doctorates indirectly-through at least three nonaccredited organizations, one of which shares a toll-free number with both the school and a mail-order house that specializes in dietary supplements.

Apparently, the aforementioned lawyer lost only money. But there is much more at stake. In the late 1970s, Kurt W. Donsbach (pronounced "donsbah"), D.C., founded Donsbach University, which offered correspondence courses leading to bachelor's, master's, and doctoral degrees in nutrition. Electrical engineer Gary Pace obtained a Ph.D. degree from this nonaccredited school before it was renamed, in the late 1980s, the International University for Nutrition Education (IUNE). In 1985, Pace's ad in the Nassau County (New York) Yellow Pages stated that one could determine one's "true vitamins, minerals, enzymes & glandular needs" from such tests as "hair & diet analysis," "herbal saliva," and "computerized urine& vascular analyzer." That year, then New York State Attorney General Robert Abrams filed a civil suit against Pace, accusing him of practicing medicine without a license, false advertising, and illegal use of educational credentials. Abrams said that at least 251 clients had paid Pace an average of $317 in the previous four years. According to the lawsuit, Pace had massaged women's feet, had sometimes performed lengthy and/or private mammary and vaginal exams, and had routinely requested a hair specimen (sometimes pubic). Finally, an injunction prohibited Pace form practicing medicine unlawfully and from publicizing his doctoral status.

IUNE operates as a nonaccredited "distance learning" institution in Chula Vista, California. It offers, for example, programs that lead to a Ph.D. degree in "Clinical Nutrimedicine and Biological Sciences. " Majors include "nutri-medical dentistry," "nutri-medical eye and visual health care," "nutri-medical homeopathy," and "therapeutic nutrimedicine." Five of the thirteen members of IUNE's core faculty hold graduate degrees from Donsbach University and/or IUNE.

Pseudocredentials Galore

Published studies conducted since the mid-1980s, an annual (the 1995- 1996 Holistic Health Directory), and several books -- notably the 336-page twelfth edition of Bears' Guide (see above) and the 200-page second edition of The Common Boundary Graduate Education Guide: Holistic Programs and Resources Integrating Spirituality and Psychology (1994) --suggest that healthcare-related pseudocredentialing is rampant. Pseudocredentialing includes: (1) providing certificates, degrees, diplomas, and titles in a particular field to persons who have not demonstrated competence, erudition, or expertise in that field; and (2) providing a paper facade of medical know-how to persons whose course of study in the field of the "credential" had inadequate scientific content.

Pseudocredentialism is a byproduct of credentialism, which is overemphasis on documentary (particularly educational) credentials as prerequisites to employment or as augmenters of upward mobility. In the healthcare field, where competence often is a life-or-death concern, emphasis on certificates, degrees, and licenses, which facilitate ruling out unqualified job applicants, usually does not seem undue. In some cases, however, it does seem distorted. For example, between mid-1987 and 1993, I worked in two healthcare facilities where non-R.D. food service managers without graduate degrees had authority over chief dietitians who were R.D.s with healthcare-related master's degrees.

While credentialism shortchanges some contributors to society and inappropriately aggrandizes others, pseudocredentialism tends to cheat all consumers. It encompasses: (1) the "for-profit" use of "credentials" obtained from pseudocredentialing organizations and (2) the misuse of bona fide credentials (e.g., registration with the Commission on Dietetic Registration) in an area where these credentials have little or no importance (e.g., medical diagnosis).

"Credentials" listed uncritically as "professional titles" in The Common Boundary Graduate Education Guide include: Acupuncture Physician (Ac. Phys.), Certified Acupuncturist (C.Ac.), Certified in Classical Homeopathy (C.C.H.), Diplomate in Homeotherapeutics [i.e., homeopathy] (D.Ht.), Doctor of Acupuncture (D.Ac.), Doctor of Oriental Medicine (D.O.M.), Homeopathic Medical Doctor (H.M.D.), Licensed Acupuncturist (L.Ac.), Master of Acupuncture and Oriental Medicine (M.Ac.O.M.), Naturopathic Medical Doctor (N.D. or N.M.D), Oriental Medical Doctor (O.M.D.), and Registered Acupuncturist (R.Ac.). Because the predominant forms of most or all of the methods that underlie each of these "titles" lack scientific substantiation, I consider them pseudocredentials --signs of shaky philosophies that inspire little or no confidence in the scientific community.

Below I describe several relevant studies.

In early 1986, the National Council Against Health Fraud (NCAHF) published the findings of its study of practitioner listings in the Yellow Pages under the headings "Dietitians" and "Nutritionists" within the preceding four years. The principal finding of this study, which covered 41 areas of 17 states, was that only 13 percent of 439"nutritionists" appeared qualified. Furthermore, 46 percent of 24 physicians listed in a subsection titled "Nutrition" (under the heading "Physicians and Surgeons") were "clearly spurious," and none appeared qualified. Their offerings included acupuncture, chelation therapy, life extension, orthomolecular medicine, and orthomolecular psychology.

In a comprehensive 1992-1993 Yellow Pages study sponsored by the NCAHF, Ira Milner, R.D., collected data from 64 areas of 32 states. The principal finding was that consumers had less than a fifty-fifty chance of finding a reliable "nutritionist" through the directory. Task-force volunteers consisted of registered dietitians (R.D.s), public health nutritionists, dietetic interns, and postsecondary nutrition students. They categorized 21 (9 percent) of the 231 businesses listed under the heading "Dietitians" as "spurious." These included Diet Center facilities, health food stores, multilevel-marketing distributors, a nutritionist with a dubious doctorate who practiced iridology [see NF 6:4-5, 1989], and a former vitamin company salesman who used hair analysis [see NF 11:23-24, 1994].

The "credential" initials used by dubious nutrition practitioners included: CCN (Certified Clinical Nutritionist), CN (Certified Nutritionist), CNC (Certified Nutrition Consultant), NC (Nutrition Counselor), NMD (Doctor of "Nutrimedicine"), ND (Doctor of Naturopathy), OMD (Doctor of Oriental Medicine), HMD (Homeopathic Medical Doctor), CCT (Certified Colon Therapist), RCT (Registered Colon Therapist), CMT (Certified Massage Therapist), and MLD (Manual Lymph Drainage).

In September 1992, I telephoned all businesses listed under the headings "Dietitians" and "Nutritionists" in the 1992-93 NYNEX Yellow Pages for Queens, a borough of New York City. Only one of the 26 businesses listed seemed a reliable source of nutrition information; at least seven were health food stores or dietary-supplement distributors. A self-styled "certified eating-disorder specialist" told me he prescribed supplements. When I complained of tiredness, he declared that tiredness is "the first sign of illness." A practitioner of "holistic nutrition" also said he prescribed supplements and stated he had an N.D. degree "from Puerto Rico." (There were, and are, no accredited naturopathy degree programs in P.R. And any naturopathy degree is a telltale of pseudo-science.) I asked where I could buy the supplements, and he said he had a "warehouse" in his office.

In early 1994, the publishers of NUTRITION FORUM sponsored a follow- up to the 1992-1993 Yellow Pages study. In the follow-up, Milner decided that 17 of the 24 self-described Ph.D.s listed under the heading " Nutritionists" held "phony" Ph.D. degrees. Apparently, eight of the dubious doctorates came from nonaccredited correspondence schools (five from Donsbach University or the International University for Nutrition Education); one came from a nonaccredited college that required attendance; and one came from the "Clayton School of Homeopathy."

In a spinoff of the 1992-1993 Yellow Pages study, I examined promotional mailings from diverse providers of alternative health education, which encompasses: (1) indoctrination in alternative healthcare (or occult medicine), in particular methods thereof, or in sectarian religious "healing"; (2) nontraditional academic programs that afford such indoctrination; and (3) nontraditional academic programs in science-oriented healthcare. Between mid-July 1994 and February 27, 1995, using NUTRITION FORUM letterheads, I mailed a one-page itemized request for perusable information and a one-page questionnaire to 50 "credentialing" organizations with addresses in 23 states. Selection of organizations was arbitrary. However, all had offered health-centered or customizable academic programs within the previous seven years. By February 26, my associates and I received course descriptions from 27 organizations, including questionnaire responses from eleven. Each of these organizations offered at least one academic program that: (1) covered human health and nutrition, or was adaptable to such a focus; (2) did not involve attendance, or required short attendance; and (3) culminated in a certificate (certification), a nondegree diploma, or a graduate degree.

The following findings pertain to the 27 organizations from which we received course descriptions during the aforementioned period.

At least 21 (78 percent) offered correspondence programs. Degrees available through nutrition-related correspondence programs included: Doctor of Divinity (D.D.), Doctor of Holistic Health (H.H.D.), Doctor of Naturology (D.N.), Doctor of Naturopathy (N.D.), Doctor of Philosophy (Ph.D.), and Doctor of Science (D.Sc.). ("D.N." also represents two other nutrition-related pseudocredentials: the degrees of "Doctor of Naprapathy" [see NF 11: 63-64, 1994] and "Doctor of Nutripathy" [see above].) A "Master Herbalist" (M.H.) diploma was likewise available through correspondence. Obtaining a "Health Educator" (H.E.) certificate required attendance at an institute for eight consecutive weeks. The H.E. certificate, the M.H. diploma, and all the aforementioned correspondence doctorates were not trustworthy.

Twenty of the organizations (74 percent) lacked (and still lack) accreditation by an entity recognized by the U.S. Secretary of Education or the Commission on Recognition of Postsecondary Accreditation (CORPA).

Six of the organizations (22 percent) claimed accreditation by entities not recognized by the U.S. Secretary of Education or CORPA.

Below I contrast two providers of alternative health education.

The Herbal Healer Academy

Founded in 1988, the Herbal Healer Academy Inc. (H.H.A.) is nonaccredited. It has a letterbox in Mountain View, Arizona. I learned of the academy from a composite alternativist mailing (Health Pak(TM) I received in October 1995. H.H.A.'s Health Pak card quoted its founder and director, Marijah McCain, N.D., M.H. ("Master Herbalist"), "DIHom" (evidently a homeopathic "credential"): "OUR MEMBERS SAVE THOUSANDS IN DOCTOR BILLS! SOME MEMBERS SAVE THEIR LIVES!!!" H.H.A.'s "Special" offer was "Private" lifetime membership for $5. The mailing I received the following month for five bucks included a laminated membership card, a copy of H.H.A.'s Fall '95 newsletter (whose "front-page headline" was ". . . AND GOD GAVE THE HERBS FOR THE HEALING OF MANKIND"); an interview with a nonpracticing chiropractor, titled "Essiac: Nature' s Cure for Cancer" [see NF 11:54-55, 1994; and NF 12:54, 1995]; a catalog of such supplements as Pycnogenol(R) [see NF 11:54, 1994], shark cartilage [see NF 12:58-59, 1995], and Super Energy (which reportedly contains ma huang [see NF 12:33-34, 1995]); a "Natural Medicine Supply Catalog"; and order forms. The latter catalog offered correspondence courses leading to certificates in acupuncture, Bach flower therapy, foot reflexology [see NF 12:61-64, 1995], "herbology, " and hypnotherapy. The acupuncture course covered "electrical acupuncture, " "electrical acupressure," "five element theory," "meridians," "Oriental diagnosis," and "Yin/Yang science"; the "herbology" course, reflexology; and the hypnotherapy course, neuro-linguistic programming (NLP [see NF 12:8, 1995]). The "Natural Medicine Supply Catalog" also stated that McCain had diplomas in aromatherapy [see NF 12:31, 1995], homeopathy [see NF 11:58-59, 1994], and Touch for Health (an offshoot of applied kinesiology [see NF 12:26, 1995]), and that she had trained with " an outstanding Brazilian psychic surgeon." There were no prerequisites for admission to any of the courses. At least two of them did not have a time limit for completion.

The main question here is not whether H.H.A.'s manner of "credentialing" by correspondence is technically sound, nor whether its certificates represent proficiency. The nuts and bolts of an academic program are immaterial if its teachings are unfounded. The main question is: Do the certificates represent science-oriented learning, or indoctrination in unscientific methods? In other words, are they credentials or pseudocredentials? Are students learning facts about methods, absorbing propaganda, or simply learning little? To all appearances, H.H.A. wants to attract would-be practitioners of the methods that are the courses' subjects. Certainly Bach flower therapy, foot reflexology, and traditional Chinese acupuncture lack scientific support ("Yin/Yang science" is an oxymoron). Thus I conclude that the academy is in the business of indoctrination, not education (which, ideally, is nonpartisan).

California College for Health Sciences

The main question regarding California College for Health Sciences (CCHS), in National City, California, is different: It is whether the school's manner of credentialing by correspondence is sound. In other words, do its degrees represent proficiency?

CCHS is accredited by the Accrediting Commission of the Distance Education and Training Council, which is recognized by CORPA and the U.S. Secretary of Education. Last summer I applied to the school's M.S. correspondence program in Community Health Administration and Wellness Promotion. (It also offers health-related correspondence programs leading to a B.S. degree or an Associate.) The application procedure was a breeze. There were only two entrance requirements: (1) a baccalaureate from an accredited school and (2) completion of an introductory psychology course. Graduation requires completion of 36 semester credits, 27 of which the enrollee must complete at CCHS. The school admitted me to the program within a month of my applying.

In October, I enrolled in the first course in the core curriculum: "Ethical Considerations in Healthcare Delivery." Designed for the course and published by CCHS, the colloquial, 380-page textbook What Is a Life Worth? (1993) is interesting despite grammatical imperfections, stylistic flaws, and typographical errors. But it's not especially user-friendly. Earning the self-contained course's three credits requires only that the student pass: (1) five"open-book" exams, which consist of multiple-choice and "true-false" items; and (2) a "closed-book" final exam, consisting of 100 items (most multiple-choice, some " true-false"), that must be supervised by a "responsible individual" who does not have a personal or professional "direct involvement" with the examinee. This is, in effect, an honor system. Students may take the final exam three times during the enrollment period (two months per semester credit).

In November, I phoned the college and inquired whether my primary candidate for proctorship was eligible. I described her as a medical librarian who (1) worked at my former place of employment and (2) was a member of the editorial board of the newsletter I coedit. An official at CCHS told me that the librarian could be my proctor.

The five "open-book" exams are half the basis of the final grade. To pass them, one need only search the textbook sections titled "Study Questions and Answers."

"Believing Is Magic"

Later in November, I enrolled in another course, titled "Health Psychology. " Unlike the ethics course, this psych course has a final project requirement, which involves interviewing five patients in a clinic or hospital regarding their pain. Supervision is not mandatory. The project is half the basis of the final grade The course materials, which I received in December, included a 114-page booklet titled Developing Self-Esteem: A Guide for Positive Success (1994). My first assignment, in effect, was to "attempt" to do all the exercises in the booklet and mail the" completed" booklet to the school. The exercises, which are self-inventories, have no bearing on the final grade. On page 44, the author declares: "Believing is magic."

Because it has an easygoing exam system, requires only one internship (a 3-credit course), and does not have a thesis requirement, CCHS' s M.S. degree may be more acceptable as an adjunctive credential than as a "stand-alone" master's degree. Nevertheless, I like the school' s organized, uncomplicated, low-cost, continuing-education approach. For credentialed health professionals employed in a healthcare facility, the M.S. program may be worth a try.

Suspicious Characteristics

Most providers of dubious credentials make good first impressions, and many have a streamlined (and therefore inviting) application procedure and minimal entrance requirements. These are not signs of pseudocredentialing but may put consumers off guard. To evaluate a "credentialing" organization, consumers often must penetrate a veneer of friendliness and/or respectability. Below is a list of characteristics that are, in my opinion, grounds for caution.

The organization does not possess accreditation by an entity recognized by the U.S. Secretary of Education or CORPA. Although the institution of academic accreditation does not protect consumers against health- related rubbish and disinformation [see NF 12: 14, 1995], accreditation by an entity recognized by either of the aforementioned agencies at least weeds out fly-by-night and financially shaky organizations.

The organization claims accreditation, but neither the U.S. Secretary of Education nor CORPA recognizes the accrediting entity.

Potential enrollees must pay to receive a course catalog.

Consumer telephone requests for printed information elicit requests for prerequisite autobiographical letters.

Literature from the organization does not specify the location of its headquarters.

The organization has changed its address more than twice within ten years.

Letters, postcards, or phone calls from the organization foretell a fee increase. During my 1994-1995 study, one program director, a naturopath who evidently thought I was a potential enrollee, spoke of such a deadline in three messages on my answering machine.

The organization makes offers of substantial tuition discounts with short time limits. An introductory mailing from the University of Metaphysics [see NF 12:60, 1995] postmarked July 12, 1995, included a "Half-Price Tuition offer" expiration-dated July 31, 1995. In a follow-up mailing, postmarked July 20, 1995, the university added to this offer a free meditation course and a "Beautiful Doctoral Graduate Lapel Pin To Wear Proudly." (See below.)

The organization mails unsolicited partial-scholarship applications to potential enrollees who have not requested a scholarship application. A mailing from the University of Metaphysics (see above) postmarked September 8, 1995, included an unsolicited scholarship application whose deadline was September 30, 1995. Persons who were unemployed, disabled, or retired, or who had a financial reason for not enrolling, qualified-with prepayment by September 30, 1995-for a tuition discount of approximately 90 percent. A "LAST MINUTE SCHOLARSHIP REMINDER" followed.

The organization offers a degree with a nonstandard wording. Examples are "Doctor of Holistic Health" (H.H.D.) and "Doctor of Naturology" (D.N.).

The person who answers the phone for the organization does not immediately state its name.

Prerequisites for admission are trivial, very flexible, or nonexistent.

The Bottom Line

Few providers of alternative health education deserve the personal consideration of health professionals who desire additional credentials; i.e., few deserve candidacy as sources of credentials for credentialed people. Even fewer deserve the personal consideration of would-be health professionals.

I think credentialing by correspondence is a viable, even promising, movement. Alas, it is a movement dominated by fast-buck artists, charlatans, and propagators of mysticism, pseudoscience, and supernaturalism.

By "nonaccredited," I mean: "without institutional, departmental, or programmatic accreditation whose source is recognized by the U. S. Secretary of Education or the Commission on Recognition of Postsecondary Accreditation (CORPA)." The U.S. Secretary of Education and CORP^ autonomously decide whether (1) to grant recognition to any functioning or would-be "accreditor" that expressly wants it, or (2) to withhold or withdraw it from such an entity. In practical terms, recognition constitutes publicizing acceptance of such an entity as an accreditor.

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By Jack Raso

Copyright 1996 by Prometheus Books. Text may not be copied without the express written permission of Prometheus Books.

Raso, Jack, Healthcare pseudocredentialing.., Vol. 13, Nutrition Forum, 01-01-1996, pp 1.