Orac gets fan mail. Yes, as hard as it is to believe, my blog sometimes ticks certain people off, and sometimes I even hear from them. For instance, last week a reader wrote me. The subject header read, “Why do you hate naturopathic physicians so much?” and the letter went something like this (OK, exactly like this other than the name of the reader, which I’ve withheld, and to whom I will refer as “T”):
Having stumbled across one of your diatribes against licensed naturopathic doctors, I can’t help but wonder what that profession has done to hurt you? If you have examined the evidence, meticulously collected by insurance companies in several states, you will see that the outcomes for patients who are treated by naturopathic doctors are very good, and cheaper, and result in fewer hospitalizations. There are, no doubt, bad doctors of all types. But, why do you find it necessary to attack an entire profession? Without them, I would probably be dead now. And, there are many others like me who are VERY grateful for the option. So, your damaging words may be preventing others from getting the help that they need.
First off, T has part of it wrong. She really does. I don’t hate naturopaths, licensed or otherwise. Rather, I consider them a danger to patients and oppose the very existence of their profession. That’s a very different thing, and I’ve discussed my reasons more times than I can remember. For instance, you can’t have naturopathy without homeopathy because homeopathy is an integral part of naturopathic training and is featured on the NPLEX, the examination that naturopaths seeking licensure in any of the states that have made the profound error of passing naturopathic licensing laws must pass. Even naturopaths who have their doubts about homeopathy make excuses for it and never completely disavow it.
However, if T wants to know why I detest naturopathy as a profession so much, an example popped up just this week. It’s from Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta and a Trudeau Fellow, who summarized a recent study he published in The Globe and Mail in an article entitled Stop those naturopaths who spread anti-vaxxer myths. The study, by Tim Caulfield, Alessandro R Marcon, and Blake Murdoch, appeared in the Journal of Law and the Biosciences. We’ll start with the summary, and then I’ll dig into the study itself.
Caulfield first notes growing concern about vaccination rates in Canada (join the club) and how more people are falling prey to concerns based on antivaccine misinformation and tells how he decided to look into one potential source of this, naturopaths:
Unfortunately, much of this science-free vaccination noise comes from health-care practitioners, especially those in the complementary and alternative medicine (CAM) community. Not every complementary and alternative practitioner pushes an anti-vaccine perspective. But, let’s face it, many do. This must stop.
“Many” is putting it mildly. I’d say that most “pure” practitioners of alternative medicine are antivaccine. Certainly, we know that naturopaths, for example, imbibe quite a bit of antivaccine misinformation in their “education.”
Working with my colleagues, Sandro Marcon and Blake Murdoch, we examined more than 300 websites for naturopaths and naturopathic clinics in Alberta and British Columbia. In this study, which was recently published in the Journal of Law and the Biosciences, we identified 53 websites that had vaccination-hesitant language and/or suggested a vaccination alternative. In other words, a significant number of naturopaths – that is, members of a provincially regulated health profession – are explicitly and publicly spreading nonsense about vaccination. And this ignoble list doesn’t include the clinics (and there are many) that make baseless claims about how to naturally “boost” your immune system.
Some of the clinics offer warnings about how vaccines contain mercury and/or reference the frequently debunked myth that vaccines are linked to autism. Many websites provide specific recommendations regarding alternatives to vaccination. For example, one clinic suggests that “as an alternative to the flu shot, you can choose a homeopathic prophylactic injection instead” and another claims that “homeopathy flu injections” are a “safe and effective alternative to the regular flu shot.”
When I read the study itself, as well as some of the accompanying news coverage of it, one thing that surprised me is that Caulfield et al only found 53/330 (16%) naturopath websites with “vaccine-hesitant” language in them or that suggested alternatives to vaccination. I would have guessed a far higher percentage. Of course, if there’s one thing I’ve learned about naturopath websites over the years, it’s that they frequently rely on vagueness about “natural” treatments and don’t always mention explicitly all of their services, at least not in detail. Also, Caulfield et al weren’t doing a comprehensive survey and were rather stringent in their criteria for flagging a website, requiring the following: “(1) discourse of vaccine hesitancy (text or links to text which demonstrate explicit anti-vaccination views or which raise issues surrounding the harms/risks of vaccination) and (2) services offered or text descriptions of alternatives to vaccinations or the flu shot.” They didn’t include websites offering natural solutions to ‘boost immunity’ or to prepare one for the flu season. If there’s one thing experience has taught me, it’s that such claims are usually a pretty darned good indicator of antivaccine views.
Caulfield et al note that the statements ranged from the obviously antivaccine, like this one:
Vaccines given to children and adults contain mercury and aluminum. Babies are especially susceptible to small amounts of mercury injected directly into their tiny bodies. It is now suspected that the increase in autism and Asperger Syndrome is related to the mercury in childhood vaccinations.
Or this one:
…children are now being given increasing numbers of vaccinations containing potentially harmful derivatives and substances such as mercury, thimerisol [sic], aluminum and formaldehydes. These harmful derivatives can become trapped in our tissues, clogging our filters and diminishing one’s ability of further toxins out.
To less blatantly antivaccine statements like this one:
The bugs in question (on the Canadian Vaccine List) can enter our systems and depending on our bodies, our histories, and mostly the bugs’ propensity, they can cause serious harm. There are certainly questionable ingredients in vaccines that have the potential to do the same.
Not surprisingly, given how you can’t have naturopathy without homeopathy, most of the vaccine alternatives, particularly flu vaccine alternatives, involve ” homeopathic prophylactic immune injection” and “immune-boosting homeopathics.” Anyone who is sufficiently familiar with naturopathy would have been able to predict this particular result. Of course, given that homeopathic remedies over around 12C are so diluted that it’s unlikely that a single molecule of the original compound remains, what these websites are, in essence, doing is suggesting that you can prevent influenza and other potentially deadly diseases with water or sugar pills infused with water.
Now here comes the part where I describe why I detest even licensed naturopaths—no, especially licensed naturopaths. Caulfield et al point out that naturopaths present themselves as “evidence-based” and that governments that license naturopaths have basically accepted their claim of being evidence-based. Basically, in most provinces (and states in the US) where naturopaths are licensed, they are, like physicians, self-regulating. In British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario, for example, naturopaths create provincial colleges of naturopathy that are responsible for setting practice standards and enforcing them among their members. Here’s a bit from the Ontario Naturopathy Act’s Professional Misconduct Regulation:
The Ontario Naturopathy Act’s Professional Misconduct Regulation, for example, states that it is an act of professional misconduct to recommend or provide a treatment ‘the member knows or ought to know is unnecessary or ineffective’. Further listed acts of professional misconduct include ‘making a claim respecting a drug, substance, remedy, treatment, device or procedure other than a claim that can be supported as reasonable professional opinion’, and ‘permitting the advertising of the member or his or her practice in a manner that is false or misleading or that includes statements that are not factual or verifiable’.
I had to laugh at this passage, given that probably 90% of what naturopaths claim about health is not “factual or verifiable.” Caulfield notes that since Alberta legislated self-regulation in 2012 for naturopaths, the provincial college has carried out only one investigation of misconduct by a member. This was the death of Ezekiel Stephan, a child who died of meningitis, which I’ve discussed multiple times here before. Of note, the parents of the child are outspoken antivaxers and represented their prosecution for medical neglect as a plot to imposed forced vaccination.
Caulfield et al also call out naturopathic regulatory bodies for promoting at the very least a vaccine-hesitant approach:
The regulatory bodies that govern and represent the profession have, to date, largely been silent or have taken remarkably soft positions on vaccination. For example, of all the naturopath college websites in Canada, only the College of Naturopaths of Ontario site contains content that speaks directly to homeopathic vaccines and vaccines in a way that restricts allowable claims to those that are scientifically proven. In this case, Health Canada’s position is merely reiterated.
Conversely, the British Columbia Naturopathic Association has published a position paper on vaccination that supports a vaccine-hesitant approach. The document is an excellent example of the ambiguous attitude of the naturopathic community to vaccines. It purports to explain the advantages and disadvantages of vaccination, at one point implying that the risks are equivalent to the benefits. The document notes that vaccine preventable ‘diseases can cause injury or death in a less than robustly healthy infant or child’, then states that ‘[i]t’s of equal importance to note that all of the vaccines for these diseases can also cause injury or death in a less than robustly healthy infant or child, and this is where most of the parental concerns arise’. It contains a list of unsubstantiated concerns such as the alleged presence of toxic preservatives and the unnatural route of entry of vaccines. The document suggests that vaccines are helpful only because without them ‘parents run the risk of their child encountering a virile disease agent at a time when their child’s immune system may be compromised by stressors such as injury and poor nutrition’. The implication seems to be that one can build up the immune system ‘naturally’ to prevent serious vaccine-preventable diseases, which is scientifically inaccurate.
This is no different from naturopaths in the US, either. For example, the American Association of Naturopathic Physicians (AANP) published a position paper on immunizations that provides at best grudging support for vaccination, noting that naturopaths, “as primary care providers, are morally obliged and legally mandated to uphold and carry out the public health mandates and should be authorized to administer immunizations in all jurisdictions where naturopathic regulation to do so exists.” In other words, vaccinate if the law tells you you have to vaccinate, but note that it “is documented that some of the current and past immunizing agents have been associated with significant morbidity and are of variable efficacy and varying necessity.”
As ex-naturopath Britt Hermes noted, the AANP position paper does not advocate the administration of routine childhood vaccines. Nor does it mention any vaccine schedule specifically or recommend a standard of care. She also noted a couple of years ago that a draft position on immunizations was leaked and appeared to be a lot more pro-vaccine. It even made the hilariously disingenuous claim that families “fired” from conventional pediatric practices for refusing vaccines often seek out naturopaths, placing “naturopathic physicians in an opportune position to provide information and vaccine coverage to those patients who might otherwise receive no vaccines at all.”
I’m sorry. I probably should have warned those of you who just spewed liquid all over your laptop or mobile device to put down your drink before reading that. In any case, I tend to agree with Britt that this was almost certainly leaked for political reasons, to make naturopaths seem more pro-vaccine than they really are. As she noted, only around 3% of naturopaths support the full CDC vaccine schedule. Indeed, pro-vaccine naturopaths are quite rare. I’ve searched for them and only ever found one or two. Even then, one such naturopath who presented herself as “not antivaccine” still expressed what were clearly what Caulfield would characterize as “vaccine-hesitant” views and cites execrably bad research by “scientists” associated with the antivaccine movement. I’ve also pointed out that, when they think no one’s listening, naturopaths routinely spew antivaccine pseudoscience amongst themselves. Indeed, there’s one of these antivaccine naturopaths in my neck of the woods named Doug Cutler. Here’s a taste:
Absolutely shameful that the biggest medical fraud (perpetuated by Big Pharma) continues to indoctrinate the public (“milk does a body good”) that vaccines are safe and effective. As you stated, we still don’t know the longterm vaccine safety so hoping that they are safe and effective for the “greater good” is unacceptable and completely immoral until we fully know.
You are right though, we need to question our personal “dogma/bias”. I fully believed in vaccines until my intimate association with hundreds of mothers that had vaccine injured children, changed that entire belief set completely around. The same amazing mothers that knew more about vaccines than any doctor or scientist out there, hands down. Then with my training and knowledge of environmental toxins, just analyzing the actual ingredients of each vaccine, one by one – I could never in good conscience justify those known toxic ingredients to have a free pass directly (no detox roadblocks) to a baby’s brain.
My disclosure, I am opposed to all sources of toxins therefore I am against vaccines whose one size approach fails to account nutritional statuses, toxic burden of mom/child and genetic polymorphisms that are at epidemic levels. 10 vaccines from birth to 6 years in 1983 and 36-38 vaccines from birth to 6 years in 2010. Insane.
I’ll conclude by saying to T that I don’t hate naturopaths. I’m sure some of them are perfectly nice, albeit deluded, people. I oppose naturopathy because it is quackery that endangers patients. One reason is that you can’t have naturopathy without antivax. The high prevalence of antivaccine views and very low support for vaccination show that. Antivaccine views are baked into naturopathic education and philosophy. That cannot be escaped.