On Friday, 28 November 2014, CBC Marketplace aired an episode (which I recommend watching before reading this) in which they sent parents and their babies to homeopaths for vaccine advice. They were exploring whether homeopaths were one of the sources of misinformation scaring concerned parents away from vaccines.
(Note: This article is not about the effectiveness or safety of vaccines and I ask the reader to consult Canadian regulations, summaries of the scientific evidence on vaccination, and the current recommended schedules for vaccination. This article is also not about whether homeopathic remedies are effective and I ask the reader to consult this evidence summary for a very detailed analysis of available evidence.)
Homeopaths are certainly not the only source of vaccine misinformation, or even the primary source, but as purported alternative health care providers, they have earned additional scrutiny. Within the context of the provision of health advice, their statements were shocking and deeply troubling, especially considering gaps in regulation of their remedies and the profession as a whole. Also disturbing was the use of autism — a supposedly vaccine-linked condition (it is not) — as a scare factor, contributing to stigma against people with autism, and the confidence and authority with which they made statements that are factually incorrect.
We are not entitled to our own facts; an aside on ethics…
This is the context in which I object to the current practice of homeopathy. The problem is more than the vaccine claims. The problem is that, despite those that have good intentions, the practice of homeopathy is far below the quality of service that Canadians should expect to receive from health practitioners and there are insufficient protections in place to ensure accountability and safety.
A patient/client has a right to informed consent, which means that any information or recommendations provided to them must be accurate (i.e., based on the highest quality evidence currently available), objective, non-judgemental, and appropriate/relevant. The client (or a substitute decision-maker) must also demonstrate reasonable understanding of the information and must unambiguously agree to recommendations, otherwise the treatment cannot ethically proceed. The practitioner must be accountable for their recommendations and maintain appropriate documentation. This is the basis of all health care interactions.
The erroneous statements made by the homeopaths in the Marketplace piece demonstrate that at least some homeopaths, regardless of their good intentions, are not ready for even this basic level of practitioner responsibility. The subsequent public responses on social media and the alleged deletion of information from websites without public acknowledgement also demonstrates a concerning lack of accountability. Finally, the accusations of conspiracy are beyond the pale for a health practitioner.
Homeopaths are not ready to be health care practitioners — a demonstration:
Homeopaths, and people who use homeopathy services, were apparently incensed and angrily took to Twitter and Facebook during and after the program aired. The vast majority of the response focused on having been secretly taped and conspiracy theories that Erica Johnson, Marketplace, CBC, and Health Canada are Big Pharma shills who target homeopaths. Many respondents retweeted each other and shared the same articles.
Keep the following in mind when considering the responses of homeopaths to CBC Marketplace:
- Homeopaths and their respective organizations have failed to provide an adequate response to Marketplace that demonstrates appropriate professional accountability. Since the program aired, there has been no reassurance from the schools or organizations promising education to their members to ensure that future client interactions will be in line with public health recommendations. Many homeopaths still continue to claim that nosodes are as effective as vaccines, despite this statement from the Canadian Homeopathic Pharmaceutical Association (CHPA): “Our association and its members cannot recommend the use of any homeopathic medication, in lieu of conventional medical vaccinations. To our knowledge there have been no homeopathic substances thoroughly tested as consistently effective replacement therapeutics for conventional medical vaccinations.”
- Health Canada does not recommend nosodes being used as vaccine alternatives (manufactured nosodes now require a warning label saying as much), but they lack authority over what homeopaths do/say. Lack of authority to act does not mean that they counter-intuitively approve of compounded nosodes (which are nosodes that the homeopaths prepared themselves).
I will highlight a few responses:
Beth Landau-Halpern wrote a blog post called “A Shot of Deceit” in which she took issue with Marketplace’s clandestine methods of data collection and stated that she is not sure which lawful circumstance(s) she met to be secretly taped (hint, they are in Beth’s article: “abuse of trust” and “no other way to get the information”). She likened her interaction with the patient as “bully” tactics, because the patient asked for a remedy for measles before leaving and Beth obliged. The implication is that she was pressured into giving the remedy, which made her look bad.
But a healthcare practitioner operates within their scope of practice and code of ethics at all times. If Beth thought it wouldn’t be appropriate to provide the remedy to “Emma” at that time, she shouldn’t have done so. So either Beth thought it was appropriate, or she allowed a patient to “bully” her into providing an inappropriate treatment. Neither circumstance is a demonstration of competence on Beth’s part, so I fail to see how this is a criticism of Marketplace or a defense of her actions.
She also threatened CBC with libel before the show aired and, as Scott Gavura discusses here, she gloated about the response from Health Canada regarding her paternalistic lack of warning to the patient and Marketplace’s subsequent complaint. The implication is that the Marketplace complaint was dismissed because it was spurious, and Beth takes the dismissal as “clearance” (i.e., that Health Canada agrees with her), when in fact it was routine bureaucracy.
Laurie J. Willberg has shared many links on Facebook and Twitter — before and after Marketplace aired — claiming vaccines are deadly, toxic, and ineffective while also claiming that homeopathy can treat or cure deadly diseases (such as whooping cough, dengue fever, meningococcal, chikungunya, cholera, ebola, etc). She has linked to known anti-vaccination organizations such as NVIC and VRAN and known anti-vaccine proponents such as Joe Mercola and the Health Ranger. Following the Marketplace piece, she tweeted prolifically about homeopathy “skeptics” (always in scare quotes, often with links to Skeptical About Skeptics), exposing an interpretive framework of persecution and battle. She directly responded to the Marketplace piece thusly:
— Laurie J. Willberg (@LaurieJWillberg) November 30, 2014
She has so far not provided any justification for her stance on nosodes and vaccines being contrary to the CHPA, Health Canada, and the government of Ontario. I also fail to see how recording statements during a clinical interaction is “entrapment”, as no homeopaths were incited by Marketplace to commit a criminal offense.
Sonya McLeod, judging from her tweets and Facebook page, has apparently also decided that anyone who disagrees with her is part of a conspiracy that spans everyone working in public health, CBC, WHO, the Canadian government, and anyone else who supports vaccines. She tweeted a blog post by Karen Wehrstein listing some studies to demonstrate that homeopathy is effective, yet concluding in the final paragraph that “It’s not scientific per se, but the popularity of homeopathy around the world is testament to its effectiveness.”
So even the Canadian Consumers Centre for Homeopathy concluded that there is no compelling evidence. If I were to base my professional conduct on popularity rather than actual evidence, I’d never prescribe exercise again.
Before and after Marketplace aired, Sonya shared and composed pro-nosode and anti-vaccine tweets. She has also since bragged about blocking “homeopathy skeptics”, indicating an unwillingness to consider evidence contrary to her beliefs. Sonya responded directly to Marketplace thusly:
Corrupt bad journalism. Marketplace censors and closes comments on “Shot of Confusion” – public not happy w biased view on #vaccines
— Sonya McLeod (@ltlmtnhomeopath) November 30, 2014
— Sonya McLeod (@ltlmtnhomeopath) December 3, 2014
— Sonya McLeod (@ltlmtnhomeopath) December 3, 2014
— Laurie J. Willberg (@LaurieJWillberg) December 3, 2014
This is an inadequate response to the significant professional and public health issues exposed by CBC and an inadequate defense of recommending nosodes, despite the stance of the CHPA. Health practitioners are obliged by professional ethics to change their practice, if necessary, based on evidence to ensure best practice for the client. Sonya blocks out any disagreement, demonstrating an inappropriate and unethical relationship with evidence with respect to client care.
Access Natural Healing Holistic Health Centre set up a Facebook page several years ago with the apparent intent of allowing homeopaths to warn each other of CBC investigations (e.g., past posts to the page show shares/posts of CBC ombudsman complaints) in addition to general information about homeopathy. The comments and a link to a blog post from 29 September 2014 seem to indicate that homeopaths felt burned by another Marketplace special on homeopathy from 2011 (Cure or Con) and were distrustful of them the second time around.
A post from 25 August 2014 indicates that a producer from CBC Marketplace contacted a homeopath named Elena Cecchetto of Access Natural Healing via email following a visit and follow-up phone call. The post alleges that CBC never contacted them before the email and that “Erica Johnson of Marketplace is at it again”. The email states that CBC visited the clinic and documented their interaction with Elena, during which it was claimed that nosodes were “over 90% effective”. CBC then invited her to speak to them on camera about their findings. In the comments, Elena indicated that the same letter was sent to Sonya McLeod and Beth Landau-Halpern indicated she got the letter as well.
This indicates that at least 3 months passed between Marketplace’s initial investigations and airing their show, but during that time none the homeopaths that were contacted agreed to speak to them about their evidence. Now, if I believed I was being set up, I probably wouldn’t want to be on CBC Marketplace either. But 3 months is plenty of time to organize an independent rebuttal demonstrating conclusively that there is sufficient evidence to support their clinical recommendations and claims about vaccines. They have not done so.
Susan Drury responded to Marketplace in an email bulletin, accusing them of cherry-picking and again taking issue with being secretly filmed. She does not provide supportive clinical evidence or specifically address how she was cherry-picked.
I believe that most homeopaths truly do want to help people. But without proper oversight and guidance, they are putting their much-admired desire to help people to disappointing use and are exceeding Health Canada’s ability (or willingness) to reign in their potentially damaging clinical recommendations.
Homeopaths’ main complaints with CBC Marketplace seem to be:
- They were secretly taped, which is deceit, entrapment, etc. (as contextualized by the overwhelming focus of their responses).
- They were misrepresented or taken out of context.
- The show did not provide false balance about vaccine shortcomings (and they don’t mean known shortcomings like vaccines not being 100% effective or the risk to people with egg allergies, etc.; they mean the unproven “shortcomings” of having killed children or caused autism — as contextualized by their social media links and claims).
- CBC Marketplace are Big Pharma shills and their show was propaganda.
Here is my response to each of these complaints:
- A health professional should be able to stand by their recommendations, because they should be clinically justified. The same client interaction should take place with or without a camera.
- The Marketplace footage shows full, naturally-occurring statements that are factually incorrect and contrary to public health recommendations. Homeopaths have not adequately addressed the factual inaccuracy of their statements. Rather, many have continued to make pro-nosode and anti-vaccination statements on their personal social media accounts, while at the same time claiming the Marketplace piece was biased and deceitful.
- I have yet to see a single adequate response that directly and clearly justifies their clinical reasoning in providing advice that is contrary to public health recommendations and their own pharmaceutical association regarding nosodes and vaccines.
- If Marketplace are shills for Big Pharma, then who is CHPA shilling for? Homeopaths have a conflict of interest, in that they stand to gain financially by vilifying mainstream medicine and selling their own remedies in addition to the cost of a consultation (for example), yet they have accused CBC Marketplace (and anyone else who accepts public health recommendations that run counter to homeopathic advice) of being government and Big Pharma shills spreading propaganda. It is not propaganda to carefully consider evidence and present an appropriate conclusion.
If homeopaths want to act as health professionals, they must also accept the responsibilities of health professionals including obtaining informed consent, having professional accountability, minimizing and disclosing relevant conflicts of interest, providing robust supporting evidence for clinical decisions, and changing their clinical practice as evidence dictates. The responses of homeopaths so far have not sufficiently met any of these criteria.