The death of Ezekiel Stephan: Quackery and antivaccine views go hand in hand

About a month and a half ago, I became aware of the case of Ezekiel Stephan, a 19-month-old Canadian toddler living in Alberta who in 2012 developed bacterial meningitis. Unfortunately for Ezekiel, his parents, David and Collet Stephan, were believers in alternative medicine. They didn’t take Ezekiel to a real doctor. Instead, they relied on herbal remedies and consulted a naturopath while their child suffered and died. As a result, they were put on trial for failing to provide the necessaries of life for Ezekiel. During the trial, they raised money by appealing to the worst quacks, claiming they were being persecuted in a plot by the Canadian government to impose forced vaccination.

Last night, after a long trial, a verdict was rendered:

A packed Lethbridge, Alta., courtroom erupted with emotion on Tuesday afternoon, after two parents accused of letting their son die from bacterial meningitis were found guilty.

David Stephan, 32, and Collet Stephan, 36, were charged a year after their nearly 19-month-old son Ezekiel died in March 2012, under Section 215 of the Criminal Code which deals with “failing to provide the necessaries of life.”

There was a gasp in the courtroom as the decision from the four-man, eight-woman jury came down. People in the courtroom’s gallery started to cry and Collet Stephan broke out sobbing uncontrollably while her husband and others rubbed her back.

The Stephans will not be held in custody at this time, but will have to return to court on June 13 when the date for sentencing will be set.

One of the reasons I got into blogging about quackery is because of how often I’ve seen stories of children victimized by it. I might repeat till I’m blue in the face that I firmly believe that a competent adult has the right to pursue any medical treatment he wishes, even if it’s quackery or even if he decides to accept no treatment at all. Obviously the flip side of that is that quacks do not have the right to lie to these competent adults; that, as far as I’m concerned, is fraud. Children, however, are different. Because they are not considered competent to make their own medical decisions, they rely on the judgment of their parents. Those parents have a duty to provide adequate medical care for their children.

Of course, parents are generally given wide latitude for making decisions about what is best for their children, and great deference is generally granted to parental authority and parental “rights.” It is this deference that can become a problem in protecting children from their parents’ belief in quackery when they become seriously ill. The example that I tend to cite most frequently comes from Philadelphia and the case of Herbert and Catherine Schaible. The Schaibles were a couple who chose prayer instead of antibiotics to treat their two year old son Kent in 2009. Kent ultimately died from his bacterial pneumonia.

In spite of this horrific failure of parental duty, thanks to the deference courts have towards parental rights and, of course, religion, the Schaibles didn’t lose their surviving children, nor were they sentenced to prison. Instead, the Schaibles were sentenced to ten years’ probation, during which they, in essence, promised to take their surviving children to a doctor when they became ill; in other words, they promised to be good parents. That meant that four years later, in 2013, they were able to do the same thing again when their seven month old son Brandon Scott became ill in the same way. He, too, died of bacterial pneumonia because his parents chose prayer over antibiotics.

So when I learned of the Stephans’ trial, I wasn’t particularly optimistic that they would be convicted. I realize that Canada is a different country with a different legal system, but I know from past cases that it suffers from the same tendency that the US legal system does to defer to quackery-loving parents. I wasn’t sure what verdict to expect, but I wouldn’t have been surprised if the Stephans had been acquitted. Not in the least. I can only guess that perhaps some of the horrific evidence of just how much Ezekiel suffered untreated before the end, with accounts of how he could no longer drink on his own and was being given fluids through an eyedropper and how his body was so stiff that he couldn’t be placed in a car seat.

As I read about this case, I noticed something once again that I’ve seen time and time again. David and Collet Stephan are antivaccine as hell. They didn’t vaccinate their children, and, as I mentioned before, David Collet tried to blame his prosecution on a government plot to bring about universal forced vaccination.

Unfortunately, antivaccine beliefs very frequently go hand-in-hand with the sort of quackery-filled beliefs held by people like the Stephans. Similarly, the medical neglect antivaccine parents subject their children to by failing to protect them against serious diseases can sometimes presage more serious medical neglect, like that of the Stephans. There are many reasons for this. Certainly, the distrust of big pharma that feeds a belief in quackery like naturopathy contributes, given that vaccines are pharmaceutical products, but that’s not enough. Also certainly rejection of modern scientific medicine as being “unnatural,” coupled with a belief that “natural” is inherently better, even the attribution of magical levels of efficacy to “natural remedies.” Not surprisingly, such people often believe that the immunity produced by vaccination is somehow “unnatural” and therefore inferior to “natural immunity.”

Indeed, antivaccine beliefs seem to be part of pretty much every form of quackery you can imagine. Homeopaths tend to be antivaccine, believing that homeopathic nosodes can produce the same sorts of results. Chiropractors are heavily antivaccine, which is not surprising given that chiropractic rests on a foundation of prescientific vitalism. And, of course, naturopaths are very much antivaccine. Indeed, for some naturopaths, much of their business is based on the belief that vaccines cause autism and other neurodevelopmental conditions. They sell various nostrums to “detoxify” autistic children from the “toxins” in the vaccines. Some of them even use chelation therapy, even though chelation therapy can be dangerous and, in some cases, even kill. Indeed, the naturopath whom Collet Stephan consulted about Ezekiel and from whom she got some sort of herbal concoction to use to treat him, Tracy Tannis of the Lethbridge Naturopathic Medical Clinic, offers IV chelation therapy, along with a cornucopia of other quackery (such as ozone therapy), as I mentioned before.

It’s pretty clear from what I’ve read about the trial that Tannis provided Collet Stephan with an herbal remedy to treat her child without having examined Ezekiel. At the time I couldn’t help but observe how naturopaths have been so strongly lobbying for laws that allow them to function as primary care providers, the equivalent of family practice physicians, internists, or pediatricians. Yet, Tannis, even though she didn’t actually see Ezekiel, provides us with a compelling reason why naturopaths should never be given that status. When faced with a report of a child who was ill and who might have meningitis, Tannis provided an herbal remedy to the child’s mother without having done most basic thing a real physician is obligated to do before treating a serious disease, which is to examine the patient.

Then, of course, naturopathy is a belief system that is infused to its very core with antivaccine beliefs. Very rare indeed is a pro-vaccine naturopath. Indeed, the one naturopath I’ve found who claims to be pro-vaccine revealed herself to have some antivaccine proclivities when examined more closely. Indeed, that one self-proclaimed pro-vaccine naturopath claimed that there were naturopaths who are “vocal supporters of rigidly following the CDC schedule.” Now, personally, whenever I come across a claim like this, I always say that I’d love to meet these naturopaths who try to out-Offit Paul Offit. I’ve always been disappointed, as I’ve never encountered a naturopath who advocates “rigidly following the CDC schedule.” Ever. And I’ve looked. If they exist, they appear not to blog or maintain websites. Whenever I see what naturopaths have to say about vaccines, it’s either a whole lot of easily shot down antivaccine tropes, or it’s a mush, wishy-washy false equivalence between the antivaccine and pro-science-based medicine viewpoint.

There’s more promising news, too. It turns out that Tracy Tannis is facing an investigation after the parents’ conviction in response to a letter by 43 Canadian physicians echoing my thoughts on this whole case:

By any objective measure of a healthcare professional licensed to care for children Dr. Tannis did not meet the standard of care. According to what has been given as evidence in the Stephan trial, Dr. Tannis did not physically examine Ezekiel, who was so stiff from meningeal inflammation that he could not sit in his car seat when his parents took him to the Lethbridge Naturopathic Medical Clinic. Dr. Tannis has stated that she did not communicate with Collet Stephan, yet two other people have given statements that Dr. Tannis did in fact discuss viral meningitis with Collet, and gave her echinacea anyway. At no point did Dr. Tannis advise Collet that a lumbar puncture (typically performed by an emergency or pediatric physician) is the only way to distinguish between viral and bacterial meningitis. It’s unclear if Dr. Tannis is aware that bacterial meningitis is fatal if not treated with antibiotics and can cause permanent brain damage if treatment is not initiated promptly.

Regardless of how much direct communication occurred between the Stephans and Dr. Tannis, they left the Lethbridge Naturopathic Medical Clinic with an echinacea tincture they felt had been recommended by a registered naturopath. Dr. Tannis has stated that she was aware a woman was in her clinic that day requesting a treatment for a child under the age of 2. She was involved in some way in the sale of this medication yet never examined the child it was intended for. It is up to the CNDA to determine to what degree Dr. Tannis engaged with the Stephans about their very sick toddler, and to what extent she was aware that they thought he had viral meningitis. She has stated in court that the Stephans simply purchased an over the counter herbal remedy, yet they chose to go to a naturopathic clinic to make this purchase. If patients are drawn to buying treatments from a clinic rather than a health food store it is because they have a greater sense of security in doing so. That security comes with an attendant responsibility on the part of the clinic.

The degree of responsibility that Dr. Tannis bears for the tragic outcome Ezekiel Stephan suffered is a matter for the CNDA to explore and publicly address.

Exactly. If you want to be a physician, then be a doctor. Don’t just play at it. You can’t have it both ways. If you’re a doctor, you can’t go around selling herbal remedies as a treatment for suspected meningitis without taking responsibility and examining the patient and doing an appropriate workup. It’s called professionalism. Live it. Learn it. Love it. Oh, wait. I’m talking about naturopaths. They can’t and they won’t.

Unfortunately, upon reading about the investigation being opened by the College of Naturopathic Doctors of Alberta (CNDA), my thoughts immediately echoed those of Britt Hermes, the naturopath who realized that she had entered a profession rooted in quackery and left naturopathy. My first thought was that the CNDA will likely find that Tannis did nothing wrong. The reason, of course, is that there is no naturopathic standard of care—for anything. How can there be? Naturopathy isn’t based in science; pretty much anything goes. If you don’t believe me, I will simply remind you again that The One Quackery To Rule Them All, homeopathy, is an integral part of naturopathy. It’s a large part of the curriculum in naturopathy schools, and the NPLEX, the naturopathic licensure exam, tests freshly minted naturopaths on homeopathy along with all the other quackery. Basically, you can’t have naturopathy without homeopathy. Hermes, knowing more about naturopathy than I, proposes another reason why Tannis likely has nothing to worry about:

I suspect the CNDA will find no wrongdoing, not because Tannis sold an herbal product to Ezekiel’s mother who intended to use it to treat his meningitis. Rather, the CNDA will probably close the case because naturopaths were only licensed in Alberta months after Ezekiel died. Therefore, the college has no jurisdiction over Tannis’s actions at that time because she and other naturopaths in Alberta were not yet licensed.

Of course, Tannis herself isn’t the problem. It’s naturopathy itself. The licensing of naturopaths legitimizes their quackery, making it easier for irresponsible quackery-loving parents like the Stephans to medically neglect their children.

Naturopathy is quackery. No quackery is too quacky to be rejected by naturopaths, who embrace homeopathy, acupuncture, energy medicine, chelation therapy, intravenous vitamin C, applied kinesiology, and many more. The world view from which naturopathy springs, namely beliefs in vitalism and that nature is always better than “artificial” or “scientific” medicine (hint: it ain’t), is not unique to naturopaths. It’s the same world view that drives parents like David and Collet Stephan to treat their dying child with “natural” herbal remedies instead of taking their child to a real doctor before it was too late. It’s the same world view that leads people to say things like this in response to the conviction of the Stephans:

Couple that magical thinking at the heart of alternative medicine like naturopathy and embraced by the Stephans with the all too common view that sees children more as property than independent beings for whom parents are but stewards, and tragic cases like that of Ezekiel Stephan are the result. As tragic as his case is, it’s a good thing that this publicity surrounding this trial is reminding people what can happen when parents rely on quackery instead of medicine.

ADDENDUM: Steve Novella has also discussed this case.