Category Archives: Health in the Media

Discussion and analysis of news coverage of health topics.

Homeopaths Respond to CBC Marketplace

Marketplace

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:

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:

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.

Conclusion

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:

  1. They were secretly taped, which is deceit, entrapment, etc. (as contextualized by the overwhelming focus of their responses).
  2. They were misrepresented or taken out of context.
  3. 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).
  4. CBC Marketplace are Big Pharma shills and their show was propaganda.

Here is my response to each of these complaints:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

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CBS Fail

The skepticism website Skepchick has alerted the masses that CBS is airing a joint venture by Joe Mercola and NVIC (two hefty sources of anti-vaccination nonsense) alerting people to the “risks” of vaccines and their “choice” of whether or not to get them. Though by highlighting risk, it’s clear what choice they want people to make.

There’s a petition to sign. I’m not really partial to those, however there is also information on how to contact CBS directly and through Twitter with the hashtag #VaxCBS.

Are Psychics the New Therapists?

Short answer: No.

Longer answer:

Psychics/mediums are people who claim to predict the future and/or talk to the dead using paranormal powers. There is no evidence (despite years of investigation) that people have these abilities. There is evidence that psychics/mediums use a technique called “cold reading” – even when they aren’t aware of it – which is a technique that allows psychics to gather information from their client/mark using body language, other cues, and a clever tongue. This allows the psychic to appear very accurate in their information, requiring no supernatural ability. Anyone can learn to do this.

People’s self-ignorance of using a trick may seem odd, but most people haven’t tested their “abilities” under controlled conditions. This allows them to legitimately believe that they have supernatural powers through thinking errors, like one called confirmation bias (remembering hits more than misses). Unfortunately, as with most things, there are also people who are downright frauds, using cold reading with intentionally-practiced skill. They may even go so far as to use “hot reading”, where the psychic cheats by surreptitiously gathering information about their mark before their reading. Examples of psychics and their techniques can be seen in Penn and Teller’s Bullshit! episode about psychics here.

Psychics operate on a scale from small local shops to vast phone networks to a much grander scale: national TV. One example of the latter is John Edward (previously busted using both cold and hot reading techniques on his former show Crossing Over), who was recently featured on the Dr. Oz show in a segment entitled “Are Psychics the New Therapists?“, hence this topic coming to the attention of a  health blog.

Edwards and Oz essentially present the argument that grief is like a cancer that, if left “untreated”, will metastasize, and psychics/mediums are helpful in this regard. But even this one claim contains several assumptions:

  • First, as discussed above, there is no respectable evidence that psychics can talk to the dead.
  • Second, even if we assume that psychics abilities are real (or at least non-harmful), there is no evidence that they are helpful.
  • Third, in relation to the segment title, can psychics be so helpful as to replace professionally-trained therapists with evidence-based skills in grief counseling?
  • Fourth, even if psychics are real, can John Edwards – specifically – really talk to the dead? Does he deserve to be featured on this show given his history using (intentionally or not) known reading tricks?

Their “yes” arguments are less than compelling, with Dr. Oz stating:

“as a heart surgeon I have seen things about life and death that I just cannot explain and that science can’t study.”

And later:

“I can’t make up an explanation for what John Edward does. And, again, what was most eerie was his level of detail, the concreteness of it all.”

In other words, “I’ve never heard of cold reading and I assume science can’t study some things, therefore I assume psychics are real/helpful.” Dr. Oz’s ignorance about the topic and his allowance that psychics abilities “can’t be studied” (they have – psychics just don’t like the results) allows him to imply to his trusting audience that psychics are a valid form of grief treatment.

So put down your psychology textbooks and peer-reviewed clinical research, young health students, the “new therapists” are helpful because we can’t explain how it might work. ???

Forget your degree, learn cold/hot reading.

The position of critical thinkers, as with anything, is that evidence comes first. There’s no evidence that John Edward or any other psychic/medium has the capability to provide consistent therapeutic benefit for grief, let alone as much benefit as a trained professional.

Psychics/mediums are not a health profession, they have no standards of practice or code of ethics (which are required of any legitimate health provider to protect people), and they have no oversight to ensure their customers that they are legitimate (which is impossible, due to lack of supporting evidence) or that they are effective in providing their services. They likely have no training in psychology and therefore no appreciation for the harm that may be done by (intentionally or not) implanting false memories or altering existing memories of dead loved ones with their claims.

It’s unfortunate that a doctor, particularly one with such a large reach, would devalue therapeutic professions and lend authoritative “legitimacy” to the claims of unproven psychics/mediums, particularly when actual people’s lives, emotions, and personal well-being are on the line. It just goes to show how easily anyone can buy into unproven claims, no matter what their degree, if they do not practice critical thinking.

CBC Marketplace Investigates Homeopathy: A Review

Benefiting from the Atlantic Time Zone, I got to be one of the first to watch CBC Marketplace on Friday night (darn you, Newfoundland!) where they covered the topic of homeopathy. Here are my impressions.

First, I want to praise Marketplace for not offering false balance on the issue. Homeopathy is not something about which there is any serious scientific debate. The evidence is clear that homeopathy is not physiologically/chemically/physically possible, has no defined mechanism of action, and does not work beyond a placebo effect. It would be wonderful if it did work, but it doesn’t. More…

After Wakefield: Undoing a decade of damaging debate

From flickr user debsilver
It's said that you can't unring a bell

This article was co-written by Scott Gavura, Pharmacist. Cross-posted at his blog, Science-Based Pharmacy.

Immunization has transformed our lives. This single invention has prevented more Canadian deaths in the past 50 years than any other health intervention. Our parents and grandparents accepted illness and death from diseases like smallpox, diptheria, and polio as a fact of life. Mass vaccination completely eradicated smallpox, which had been killing one in seven children. Public health campaigns have also eliminated diptheria, and reduced the incidence of pertussis, tetanus, measles, rubella and mumps to near zero. More…

On Disability …and Penn and Teller

On the show Bullshit, by magicians Penn & Teller (P&T), various topics (such as UFOs, 9/11, bottled water, recycling, etc) are discussed from their unique point of view. I generally enjoy this show for its spectacle and the topics they discuss, even though they are biased (though they fully admit it). They have even admitted to mistakes, such as their stance on second hand smoke, so props to them for that. However, in my opinion, sometimes their politics interferes with their common sense and detracts from the overall quality of their arguments.

In the episode “Disability” (Season 5, Episode 7), they really screwed up big time.

Their Argument in a Nutshell

Laws (specifically The Americans with Disabilities Act) that encourage universal or accessible design and attempt to reduce discrimination are unfair because 1) they don’t perfectly encompass all disability, 2) they have led to some absurd applications of the law, 3) the cost, determined by the intrusive government rules, is absorbed by taxpayers and business-owners, and 4) they can sometimes be annoying to able-bodied people.

Yikes.

Where They Go Wrong

The argument is specious from the get-go, particularly their relatively familiar tactics designed to bias the audience towards their point. For example, in the first few minutes as they introduce the topic, they have a muscular man in a cambered, lumbar back wheelchair (for the unfamiliar, this is a chair for a relatively fit person with exceptional trunk control) wheel around several obstacles, easily clearing them.

This is, in short, not an accurate representation of the average wheelchair user. Many people in wheelchairs have comorbidities (or primary diagnoses) such as trunk weakness, inability to maintain midline gaze/head, poor hearing/eyesight/tactile sensation, weakness, etc. due to conditions like muscular dystrophy, cerebral palsy, MA, ALS, stroke, etc. Any number of other issues in addition to “can’t move legs” (which seems to be the only variable P&T took into account) can make navigating a world with steps, narrow doors, round handles, etc. too much to bear on a daily basis.

As usual, P&T have chosen the best possible example that would make their point. To use this man as a fair representation of disabled people is at best disingenuous and at worst ignorant. These kinds of attitudes towards disability have caused decades of marginalization that has been significantly reduced because of laws that enforce inclusive design.

As medical science advances, so does people’s survivability with inevitable consequences such as reduced mobility and other issues. Some people are athletic enough to have no problem with wheelchair mobility after, say, a spinal cord injury around the low thoracic level. Many other people can’t get by as easily. Ignoring the disabled was a community-level ethical issue that was not adequately addressed until there were laws.

The Penn and Teller Perspective, Point by Point

So let’s get to the main points of their argument, individually (note that these phrases weren’t uttered word for word, this is my own summary of the common themes I noticed):

1) ADA doesn’t perfectly encompass all disability.

P&T provide a few examples of disabled people who are well-adapted to their disability and dislike the ADA, too. However, if these people are functionally able to go about their daily business in an adapted way on their own without the need for a law, are they the kind of “disabled” that is the target of laws like the ADA? I would argue that they are not, though they do potentially benefit from the legislation due to associated shifts in community perception and participation.

They also go to the other end of the spectrum and demonstrate how a person in an iron lung can’t fit through the doors designed to allow wheelchairs through. They make the argument that because the laws aren’t truly universal, the ADA is pointless. Though it is unfortunate that some people are still unable to participate fully in society because of design limitations, the millions of disabled Americans who have been greatly liberated by these laws may feel differently about the so-called pointlessness of the ADA.

Arguing for improvement is one thing, but arguing that the entire Act is useless because the regulations aren’t truly universal is ridiculous. This argument also ignores other functions of the Act — civil rights improvements and community acceptance through raised awareness.

2) Some applications of ADA are absurd.

P&T provide examples of silliness, such as braille on a drive through sign, as if those examples negate the entire premise that we should be striving for a more universally accessible society. They don’t. Bureaucracy and inappropriate application are not relevant to the spirit and utility of the ADA as a whole.

They also take issue with the fact that people with cognitive deficits can park in handicapped spaces. Who are P&T to judge what levels of disability aren’t disabled enough to “deserve” a parking space? That is, quite frankly, deeply disrespectful to all people living with a cognitive deficit. There are arguments to be made about the difficulty (for some people) or relative ease (of others) in achieving disability status under the ADA, and therefore gaining the associated “benefits”, but to completely dismiss an entire group of disabled people as if they are undeserving of consideration is inexcusable. It is not the fault of the cognitively disabled that some other people may try to take advantage of the ADA.

3) The cost, determined by the intrusive government rules, is absorbed by taxpayers and business-owners. We can’t legislate compassion; business owners are encouraged to have universal design because it would increase business.

The history of the disabled in America before the ADA begs to differ with the latter part of this argument. In fact, the story about the man who was complaining about the cost of putting in a ramp indicates that priorities tend to center on the bottom line over human compassion. I also take issues with the argument against ramps because they’re supposedly ugly. Irrelevant.

Should we abandon the goal of universality because some business owners are not getting appropriate subsidies for ramps and other adaptations? Again, the failure to successfully apply a law is not a reflection on its necessity or overall usefulness. Perhaps there is room for improvement and greater incentives for people to make these changes (as perhaps accommodating fellow citizens is not motivation enough), but that does not mean the law itself is unjust or unnecessary.

4) ADA regulations can sometimes be annoying to able-bodied people.

Handicapped parking spaces. Now, there are admittedly issues with this practice (such as the habit of putting these spaces in the busiest and most dangerous area of the parking lot) that should be addressed, but why shouldn’t people with disabilities be accommodated in public parking areas when it causes very little extra effort (if at all) on the part of able bodied people?

While it may seem silly, I’d like Penn & Teller to try and wheel themselves to and from a grocery store parking lot (maybe even in the snow), weaving their way through cars looming over and whizzing by and compare that to their everyday experience of being parked a mere 5-10 extra feet away. Or see a person with a significant cognitive deficit navigate the confusing hustle and bustle of the lot. Seriously.

Regular parking spaces are too small for most adapted cars. So people in wheelchairs can park in a regular space, but they can’t use their ramps to get out. Wheelchairs also tend to have a lot of gear on them and are heavy to cart around.

To complain about a minor perceived inconvenience to an able-bodied person as justification for not accommodating the disabled is extremely selfish. It’s easy to be annoyed with these things when there’s nothing wrong with you.

Accessibility and Politics

We need to get it through our able-privileged skulls that we should be building accessible in the first place. I recognize that there is a significant financial cost to making adaptations in existing buildings, but isn’t it unjust to not be able to leave the house because it’s not possible to get in anywhere? Do handicapped people not have the right to go where they please like the rest of us, particularly government and civic institutions? While I agree that the ADA may not always be applied in the best way, and there is certainly room for criticism, overall it has seemed to do more good than harm and its faults do not negate its necessity.

Unfortunately, I think that much of this episode stems from libertarian beliefs that government should not interfere with behaviour. P&T seem more annoyed that the government has made a law forcing people to “be nice” than they are with the ADA itself. However, one role of government is to recognize societal issues and deal with them accordingly with the resources they possess when the people are ignorant of a problem.

Conclusion

The American Disabilities Act (ADA) is in place to protect people because, unfortunately, if there were no laws forcing public places to be inclusive, they wouldn’t be. This law was born out of necessity because people in privilege (in this case, the able-bodied) have the luxury of ignoring problems that aren’t theirs until something forces them to pay attention. Had we been inclusive of all people from the get-go, we wouldn’t be in a position to fix public buildings with a 1-inch lip at the door, round doorknobs, no elevators, etc. Disabled people aren’t new, they just couldn’t leave the house, were ignored, were put in “homes”, etc. The ADA has successfully, in my opinion, raised awareness of disability issues and increased independence and social participation for the disabled.

That is not to say that the issues are gone or that discrimination isn’t still a problem (it’s certainly apparent in this episode of P&T), but these laws have significantly improved the quality of life for many disabled people. Are the laws perfect? Certainly not. Are they always applied in the most sensible way? Not necessarily. But can a person in a wheelchair now board a bus to go to the grocery store? Most of the time, yes. Before these laws, the answer was almost always “no”. So, no the solutions aren’t applicable to every single disability, but they do allow for a majority of people to engage in activities from which they were previously prohibited largely because of noninclusive design.

But my biggest objection to this episode: What is the alternative? Other than to suggest that people should be left to their own devices to ensure that the disabled are able to participate in greater society, which is apparently ineffective, they make no concrete suggestions for improvements to the ADA or for what we should do instead. What a poor argument to tear holes in something that is admittedly non-perfect, but perhaps the best we can do at this point, yet provide no solution. All in order to defend selfishness.