The Alberta government is moving in a very dangerous direction in health care. Two recent announcements indicate support for both Naturopathy and Chiropractic.
On July 7, 2012 the National Post reported that chiropractic treatment will be subsidized for seniors.
Health minister Fred Horne said the government had budgeted $7-million to give elderly citizens access to the controversial treatments; those registered with the provincial health benefit plan will receive $25 per treatment, up to $200 per year.
The Alberta government de-listed the service in 2008 amid a worsening fiscal healthcare squeeze. Manitoba is the only other province to offer widely available coverage for chiropractic treatment.
The web site Science Based Medicine has over 75 articles on the practice of chiropractic, What’s the Harm counts 368,379 people killed, 306,096 injured, and Stephen Barrett and Samuel Homola, have an entire site devoted to the topic.
While chiropractic may have some benefits, the primary negative issues are practitioners unfounded belief in vertebral subluxations—the concept that spinal misalignment as the primary cause of a large number of diseases—and the use of neck manipulation as a necessary treatment.
From Stephen Barrett:
Robert Braile, D.C., maintains a Web site “dedicated to spreading the word of chiropractic worldwide.” He apparently believes that everyone needs periodic spinal evaluations and “adjustments.”
Braile’s Web site contains two sample scripts that can be used to persuade patients to set the tone for the patients’ future dealings with the clinic. The first script describes the “straight” chiropractic belief that spinal misalignments (“subluxations”) are the underlying cause of ill health. The second script is used to describe the alleged subluxations and why chiropractic treatment is needed. Braile indicates that the use of this script in his clinic promoted “consistency” among the staff members so that. “Patients will then be educated to the same level regardless of which doctor they see.”
…In other words, the chiropractor will invariably (a) find “the basic fundamental underlying cause of all, or nearly all problems” in the spine, (b) offer to correct them with spinal “adjustments,” and (c) advise that feeling better is not a reason to discontinue “treatment.”
Most chiropractic practice-building consultants encourage this type of approach. I suspect that at least 20% of chiropractors use it.
Jann Bellamy has an article at Science Based Medicine on the backing of chiropractors for subluxation despite the lack of evidence to support the belief. (I refer to these practices as ‘beliefs’ because there is no science behind them). Sam Homola, a chiropractor, also decries the pseudoscience behind subluxations.
The other major problem with chiropractic is the also unfounded belief that neck manipulation is a useful treatment with very small risk of negative effects. In actuality, there is a very real danger of stroke following these manipulations. Sam Homola and Harriet Hall at Science Based Medicine both discuss this problem and the negative risk/benefit ratio for the procedure.
In all fairness, there are many chiropractors who do not subscribe to, or practice, these dubious treatments. However, in supporting the practitioners, the Alberta government does not differentiate between those who base their practices on science from those who base their treatments on pseudoscience.
From The National Post on July 26, 2012:
Homeopathy, chelation therapy and vitamin injections will soon be regulated procedures in the province of Alberta, which is rapidly becoming more friendly to alternative medicines that have little or no scientific backing.
Following several other provinces, including B.C. and Manitoba, Alberta this week announced it would establish the College of Naturopathic Doctors of Alberta to oversee the licensing and disciplining of its practitioners in the province.
Health minister Fred Horne said the move recognized an increasing number of Albertans were seeking alternative medicines.
“We want Albertans to feel as secure in the education, competencies and skills of practitioners to perform naturopathic services as they feel when they visit a medical doctor for medical services, or a dentist for dental services or any other regulated health professional.”
Although Mr. Horne said the government did not endorse any course of treatment — nor does the province pay for naturopathic therapies — he acknowledged the announcement would be a milestone for the profession.
“By granting self-regulation, we’re attesting, as elected representatives, to the public that we believe the practices that will be engaged in by professionals are safe and that they’re effective and that they meet the highest possible standard.”
Naturopaths are CAM practitioners who subscribe to a vitalist, or energy based, concept of life and believe, among other things, that disease is caused by imbalances in qi and that bacteria and viruses proliferate after a person is ill (despite the fact that the germ theory of disease is a well established fact). Many also do not support vaccinations.
Kimball Atwood, an American physician, and strong advocate for basing medicine on scientific principles has written extensively on the topic of naturopathy. For example:
Naturopathy: a critical appraisal.
“Naturopathic medicine” is a recent manifestation of the field of naturopathy, a 19th-century health movement espousing “the healing power of nature.” “Naturopathic physicians” now claim to be primary care physicians proficient in the practice of both “conventional” and “natural” medicine. Their training, however, amounts to a small fraction of that of medical doctors who practice primary care. An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices. Despite this, naturopaths have achieved legal and political recognition, including licensure in 13 states and appointments to the US Medicare Coverage Advisory Committee. This dichotomy can be explained in part by erroneous representations of naturopathy offered by academic medical centers and popular medical Web sites.
In another article, Atwood provides a rationale for why the licensure of Naturopaths is not in the best interests of the public.
The Massachusetts Medical Society strongly opposes naturopathic licensure in Massachusetts. Our reasons include:
- Naturopathy is both potentially and actually injurious when practiced according to the accepted standards of the profession. This injury is likely to be due to the failure of the naturopathic practitioner to recommend appropriate medical treatment.
- Unscientific naturopathic beliefs pose irrational challenges to proven public health measures, most notably childhood immunizations.
- Irrational, unscientific beliefs and practices abound in naturopathy, likening it more to a cult than to a valid form of health care. These beliefs and practices are not merely at the fringes but are the standards of the field. They are advocated by the leaders themselves.
- Naturopathic practitioners are incapable of self-regulation commensurate with public safety. No study has demonstrated that naturopaths who attend full-time schools are any less dangerous than those who have mail-order degrees.
- Naturopaths prescribe numerous “natural medicines” with a standard for safety and efficacy that is unacceptably low, as evidenced by the leading textbook in the field.
- The scientific pretensions of naturopathy and naturopathic training programs are baseless. There is ample evidence that the basic science courses do not teach students to think critically. Research performed at naturopathic colleges is lacking in scientific rigor and has not investigated common naturopathic claims. The libraries at naturopathic colleges are filled with books and journals that promote trendy but implausible notions regarding health care. The major journal in the field is filled with articles that are both absurd and dangerous. The oft-repeated claim that the major textbook in the field cites “more than 10,000 scientific references” is a misrepresentation, as exemplified by the textbook’s claims for “natural remedies.”
- Collaboration with medical doctors is uncommon in naturopathic practice.
- Naturopathy involves many nonsensical diagnostic practices that mainstream medicine considers quackery but naturopaths consider standard.
- There are ubiquitous claims of dubious clinical “syndromes,” among which are multiple “food allergies,” “toxemia,” and chronic yeast infections, which cast further doubt on the science and ethics of naturopathic practice.
- The duration and setting of naturopathic clinical training, even overlooking its content, is inadequate for producing competent primary care physicians. This is clear from a comparison of the training of medical doctors to that of naturopaths. Just as a newly graduated medical doctor, no matter how well-intentioned, would not be allowed to assume the role of a primary care physician, neither should this be allowed for a naturopath whose training is clearly inferior.
Naturopathic services are not covered by Medicare or most insurance policies. Expansion of naturopathic licensing will make naturopaths appear more legitimate and could help them gain passage of laws forcing insurance companies to cover their services.
It is unfortunate that the Alberta Government apparently ignored advice of experts such as these in making its decision.
At the premiers meeting in Nova Scotia this week, the future of health care is one of the major points for discussion. A report prepared by Saskatchewan Premier Brad Wall and Prince Edward Island Premier Robert Ghiz will discuss how the provinces can deliver better care and save dollars at the same time.
The working group examined three areas: the type of work performed by health-care providers, such as doctors and nurses, and how much responsibility they should have in treating patients; human resources management and salaries, and how provinces can collaborate rather than compete for workers; and clinical practice guidelines, including the types of treatment provided to patients.
Let us hope that the emphasis in on medicine based upon scientific principles.
As the population ages, and medicine based upon science keeps many alive longer, health care in Canada will continue to devour a higher percentage of both public and personal finances. In order to provide the most cost effective services, treatments and advice based upon science must take precedence over those based only upon pseudoscience and wishful thinking.