In the aftermath of an Alberta court's guilty verdict against the parents of 19-month-old Ezekiel Stephan, who died from meningitis after they used natural remedies and didn't seek conventional medical treatment, a Toronto physician is questioning Health Canada's policies on natural products.
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"There are people who will seek this sort of care regardless of what Health Canada says," said Dr. David Juurlink, who specializes in clinical pharmacology and toxicology at the University of Toronto. "What irritates me and most other science-minded people who care about public health is that the federal government effectively legitimizes this nonsense."
According to Health Canada's website, its Natural and Non-Prescription Health Products Directorate "assures that all Canadians have ready access to a wide range of natural health products that are safe, effective and of high quality."
Health Canada assesses "all natural health products before letting them be sold in Canada," the website says.
But natural health products do not undergo the same scientific testing for effectiveness required for pharmaceutical products, Juurlink said.
In Juurlink's view, Health Canada's approval is misleading to the public, who may view it as an endorsement.
"An unwitting consumer might view that as evidence of effectiveness," he said. "It's no such thing.
"There's a legion of quacks out there who are ready to prey upon this gullibility," Juurlink said.
"They can make a lot of money pushing their products and services to people who find the philosophy appealing but don't realize that what they're being sold is just absolute garbage."
Products have 'two routes to market'
Heather Boon, dean of the Leslie Dan faculty of pharmacy at the University of Toronto, is also the current chair of the Interdisciplinary Network for Complementary and Alternative Medicine Research (INCAM), which studies natural health therapies and their use.
"I think a lot of this can be solved by all of us talking to each other a little bit better rather than this 'either or' [approach to natural versus conventional medicine]," Boon said, noting that educating the public about natural health products and what Health Canada's approval really means is essential.
Cases like the tragedy in Alberta, where people refuse conventional care, are "very rare," Boon said.
Research shows the "vast majority" of consumers who use natural products also turn to conventional medicine, she said.
For example, Boon said, many patients with cancer will have radiation and chemotherapy but will also take vitamin supplements in an effort to boost their immunity.
But Boon agrees with Juurlink that most natural health products currently regulated by Health Canada do not have scientific evidence of their effectiveness.
The problem, she told CBC News, is that Health Canada has "dual mandates": to make natural products and therapies that Canadians have asked for accessible, while also making sure products are safe and — ideally — effective.
Much of the general public doesn't realize there are "two routes to market" through Health Canada, Boon said. One is by licensing products, such as pharmaceuticals, through scientific trials, which is what "most people assume" regulation is based on.
But the other route, she said, is approval based on "traditional evidence," where manufacturers show the product has been used for at least 50 consecutive years within a traditional system of medicine, such as Chinese or Ayurvedic practices.
Traditional vs. scientific evidence
"The idea was to allow access to those for Canadians to make informed decisions," Boon said. "[But] the informed decision piece somehow got lost in all of this because Canadians can't easily tell whether a product is approved based on traditional evidence … or it's been approved based on scientific evidence."
Boon advises Canadian consumers to look closely at the labelling. If the bottle says the health product is "traditionally used as" or mentions "traditional," that means it was approved based on traditional evidence, not through scientific clinical trials.
Boon said her "rule of thumb" is that patients should get conventional medical attention — seeing a medical doctor or nurse and taking prescribed medication — for any acute illness or injury, including a high fever or if someone has been sick for a couple of days.
More research has been done on natural health products as prevention and for chronic conditions, she said, and they can often be used in those circumstances as long as patients make sure all their health-care providers — conventional or naturopathic — know all the medicines and supplements they are taking to avoid adverse drug interactions.
No natural health product approved to treat meningitis
Juurlink said he understands that people sometimes turn to natural therapies because they don't trust drug companies.
"I am, as doctors go, about as skeptical of 'big pharma' as anyone can be," he said. "[But] the fact that drug companies sometimes act unethically or even criminally does not mean that natural health products are inherently better.
"The fact is that they [conventional drug companies] do produce some medicines that improve the quality of life and sometimes save lives," he said. "People do generally benefit from the therapies that we prescribe."
In an emailed statement, Health Canada told CBC News it "has not approved any Natural Health Products (NHPs) with a claim of treating meningitis," in reference to the Alberta court case.
"In any situation in which a serious medical condition is present or even suspected, especially in children, appropriate medical care should be sought immediately," the statement said. "It is not permissible to sell or advertise such products for the treatment or cure of serious diseases."