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A recent blog post by a British Columbia naturopath is raising questions from health professionals about the practice of naturopathy, and the use of homeopathic remedies. Anke Zimmerman, a Victoria-based naturopath, wrote a blog post on how she treated a child’s behavioural problems with a remedy made from a rabid dog’s saliva. (UPDATE 4/21: The original post has been pulled down, but a PDF as it existed on April 18 may be found here.) This led to letters from British Columbia’s public health officials to the federal regulator, Health Canada, asking how this remedy could have come to be approved for sale in Canada. As per the CBC:

A B.C. naturopath’s claim that she treated a small child’s behaviour problems with a homeopathic remedy derived from rabid dog saliva has prompted a letter to the federal government from the province’s senior public health official. Provincial health officer Dr. Bonnie Henry said she will be writing to Health Canada to protest its approval of a treatment known as lyssinum after reading a blog post written by naturopath Anke Zimmermann of Victoria. Henry wasn’t aware of the substance before reading Zimmermann’s post, but said she has already expressed concerns to the federal government about the regulation of homeopathic products.

Zimmermann is a licensed naturopath in British Columbia, and she’s using a product that has been approved by Health Canada. How did it come to this?

Naturopathic doctors are not medical doctors

Naturopathy has been described at SBM as a chimera, something that’s imagined, but in reality is illusory or impossible to achieve. That’s an apt description, as the practice is a strange assortment of unorthodox, discarded, and disparate alternative health practices, linked by a philosophy based on pre-scientific ideas of medicine. “Naturopathic Doctors” promote themselves as health professionals capable of delivering primary care, akin to medical doctors. However, there is little in common between medical doctors and “naturopathic doctors”. Naturopathy is actually an alternative medicine practice that encompasses a variety of modalities including homeopathy, herbal medicine, and Traditional Chinese Medicine.

Naturopaths may use conventional medicine as part of their practice, but this tends to occur only when its use aligns with the naturopathic belief system. What makes a treatment or intervention “naturopathic” is based on the belief in vitalism, the idea that living beings have a “life force” not found in inanimate objects. While vitalism was disproved by Wöhler in 1828, this idea remains the central dogma of naturopathy and informs much of its practice.

The naturopathic curriculum is filled with pseudoscience, and there is no convincing evidence to show that naturopathy offers anything that is uniquely useful or incrementally better than “conventional” medicineBritt Hermes is a former naturopath and has written extensively about naturopathy, and her perspective is clear: There are no naturopathic standards of care and naturopathic training is very different than what naturopaths claim. She argues that naturopathy has too much quackery and that what actually makes naturopathy unique is its embrace of pseudoscience. Despite this, naturopaths are regulated and registered in British Columbia. The British Columbia Naturopathic Association even describes naturopaths as “medically trained”:

BCAN Naturopathic Medicine Week

Given there is a lack of objective evidence that determines what naturopaths offer, concerns have been raised about the naturopathic standard of care. A letter published in Allergy, Asthma, & Clinical Immunology documents the concerns about naturopathy in Canada and any naturopathic alignment to science-based methodologies. Timothy Caulfield and Christen Rachul found that the most widely advertised practices in Alberta and British Columbia lacked a sound evidence base. They concluded:

A review of the therapies advertised on the websites of clinics offering naturopathic treatments does not support the proposition that naturopathic medicine is a science and evidence-based practice.

Among the interventions promoted by naturopaths were homeopathy, chelation, acupuncture, and hydrotherapy, none of which have any credible science to back them up. But homeopathy deserves special mention in the array of treatments used by naturopaths, as it’s the one Zimmermann endorses for the treatment of behavioural issues in children.

Naturopathy and homeopathy

As scientific principles became the framework for determining what works (and what doesn’t) in medicine, we’ve seen a steady progression towards more science-based, evidence-based care. Yet some unscientific practices still exist, even when we know they don’t work. It might surprise you to learn that some people believe sugar pills can prevent and heal disease. This belief system, called homeopathy, is a multi-billion dollar industry worldwide. Homeopathy is an elaborate placebo system, based on the idea that “like cures like” (which is simply a form of magical thinking) involving successive dilutions of products in water, like Berlin Wall, “Mobile Phone (900mHz)“, and even the light reflecting off Saturn. These substances are believed to have medicinal effects, and the dilutions are believed to increase, not decrease, the potency of the final product. But the dilutions in homeopathy are so great you’re usually not even getting any Berlin Wall. Think of putting one drop of a substance into a container of water. Only that container is 131 light-years in diameter. That’s the equivalent of the common “30C” dilution. Homeopaths believe that the water molecules retain a “memory” of the original substance (while conveniently forgetting all the other products it has come in contact with.) The final remedy is diluted so completely that most products on store shelves don’t contain a single molecule of the ingredient listed on the label. After all that dilution, the water is dripped on tablets of sucrose and lactose: They are, as a final product, sugar pills. Chemically indistinguishable, and as medicinal as a box of candies.

While there is no convincing evidence to demonstrate that homeopathic treatments are more effective than a placebo, many consumers and alternative health providers like naturopathy accept homeopathy as a legitimate health treatment. (It’s actually considered “core clinical science” within the practice of naturopathy.) Responding to the perceived consumer demand for these products, government regulators have had a difficult decision to make: They could ignore homeopathy as a health practice, treating it like we might think of astrology: firmly outside of medicine, and for entertainment purposes only. Or they could choose some form of regulation, targeting the providers (homeopaths and naturopaths) or the product (homeopathy), possibly with the goal of managing its use, or perhaps limiting harms to consumers. The risk of regulating nonsense is the perceived legitimacy that recognition and regulation implies. Regrettably, regulation in many countries has had that exact effect. There are now hundreds of indistinguishable homeopathic remedies that have been reviewed and approved by Health Canada, based what turns out to be an astonishingly low evidence bar. Health Canada will even allow references to homeopathy textbooks written in the 1800s as “evidence” of a product’s efficacy. There is no requirement for any randomized controlled trial or any other form of evidence that could actually show efficacy.

Health Canada’s low evidence standard was demonstrated by the television show CBC Marketplace back in 2015. Having previously described how homeopathic remedies lack any medicine at all, they went one further, and decided to test Health Canada’s own licensing process. They applied for approval to market a homeopathic remedy they named “Nighton” (an anagram of “nothing”) to be used to treat fever and pain in infants and children. For evidence, they submitted a few pages photocopied from an old homeopathy textbook. No trials were conducted and no safety data was provided. Just some forms, a few photocopies and a fee. Without any questions, their product was approved and licensed as a “natural health product”, and for a time, was listed in the national database of health products Health Canada declared were “safe, effective, and of high quality.”

Homeopathy for behaviour problems?

Naturopath Anke Zimmermann describes in a sort of “case study” how she came to use a remedy made from the saliva of rabid dog:

This is a 4-year-old boy who is suffering from an inability to fall asleep at night, a fear of the dark, of wolves, werewolves, ghosts and zombies and who frequently hides under tables and growls at people. He is overly excitable and has a tendency to defiance. He was normal as a baby, not affected by sleep or temper problems. There is a history of a dog bit [sic] which drew blood. I decided to give a homeopathic remedy made from rabies. The dog that bit him may have recently been vaccinated with the rabies vaccine or the dog bite in and of itself may have affected the boy with the rabies miasm. Either is possible and the phenomenon is welll-known in homeopathy.

A bite from an animal, with or without rabies vaccination has the potential to imprint an altered state in the person who was bitten, in some ways similar to a rabies infection. This can include over-excitability, difficulties sleeping, aggression and various fears, especially of dogs or wolves. This child presented a perfect picture of this type of rabies state. Most homeopaths would have easily recognized the remedy required in this case.

And she continues:

Within a minute or two of giving him the remedy Jonah smiled at me very broadly and beautifully, as if all the lights had just gone on. We said our good-byes and I felt a warm feeling of hope for this boy.

The case study goes on to describe a series of behaviours that seem to wax and wane, but Zimmermann feels the homeopathy is working:

The plot thickens, we were on the right track with the remedy. Jonah was obviously in a dog state, a slightly rabies-flavoured dog state to be more precise. Jonah’s mother told his Dad what happened in our visit and about my dog-bite analysis. Turned out that he had been bitten many times by dogs as a child and in fact, his grandfather’s dog was put down for biting him so often. Perhaps this was an added contributing factor in this case, an epigenetic predisposition.

Epigenetics? While this child seems to appear to need a medical assessment, he continued to be treated by the naturopath with the homeopathic remedy. After three weeks:

I contacted Jonah’s mother to see how he was doing and she wrote: “Though his fears at nighttime and growling still seem to have been greatly reduced, unfortuately [sic], this past week was tough for Jonah behaviourally. At school he had many seemingly unprovoked violent and aggressive outbursts towards other children. At home, he was not aggressive but certainly seemed very tightly-wound and slightly manic. He was having difficulty focusing and following any type of direction.” I had given his mother an extra dose of the remedy to take home in case of just such a need and instructed her to administer it to him.

After a few more months, Zimmermann continued to believe the homeopathy was effective:

It is obvious that the remedy worked very well for Jonah and he has been quite well for over two months. Now he is starting to relapse, which is expected. Children usually need several doses of the correct remedy over a period of months to years to completely recover. The mother shared some useful additional information about our little puppy dog boy, including that he only shows real affection with dogs and his father was also repeatedly bitten by a dog, which may have contributed to Jonah’s state as well.

I gave a dose of Lyssinum 10M.

And Lyssinum is a Health-Canada-approved homeopathic remedy. Zimmermann’s conclusion was that homeopathy was effective:

Bottom line: Homeopathy can work wonders for children with behavioural disorders if the remedy can be clearly perceived. I have seen a number of similar cases over the years which helped me to recognize the remedy in this case so quickly. Lyssinum aka Hydrophobinum is only one of many remedies that can be helpful for children with rage, aggression and various behavioural disorders. There are many others. Treatment always needs to be individualized.

I invite you to read the other cases on my website and if you know of anyone who might benefit from homeopathy, please let them know about this. Why let a child suffer needlessly when there is simple, inexpensive (the remedy cost about $15 so far) and logical solution to the problem!

I have only provided small excerpts of the entire case history above. It is well worth reading through in its entirety if only to understand the naturopatic thinking and reasoning process. It is so far removed from an evidence-based, science-based methodology, it’s remarkable.

The reaction

Health official Dr. Bonnie Henry, quoted by the CBC, has written to Health Canada, asking how this remedy could be approved. But as noted above, approval of ineffective treatments is the intent of Health Canada’s Natural Health Products regulatory scheme – not a bug. Notably, British Columbia’s naturopathic regulator is standing behind Zimmermann’s approach:

“There’s no common consensus about how the remedies work, but that they work is pretty clear. There are literally hundreds of millions of people around the world using homeopathy,” Zimmermann said. She has the support of the regulatory body for B.C.’s naturopathic doctors. According to the College of Naturopathic Physicians of British Columbia, lyssinum as an acceptable treatment. “Homeopathy, which includes the use of substances such as lyssinum, is a traditional modality with a long history in the naturopathic scope of practice; it is still used by some naturopathic doctors today,” deputy registrar Phillipa Stanaway wrote in an email.

Laughably, Health Canada says it takes safety “very seriously” despite implementing a licensing system that is doing exactly what it was designed to do.

Conclusion: Licensing magic doesn’t make it work

In Canada there have been limited attempts to regulate products like homeopathy or alternative medicine providers like naturopaths to scientific standards. In the absence of clear regulations that put science and patient safety first, it should not be surprising to see alternative medicine providers using pre-scientific practices to treat real medical issues. As long as regulators continue to allow these sorts of double-standards for these “alternative” practices, it is patients who will always, ultimately, pay the price.

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Posted by Scott Gavura