Note: Today’s post is on the same topic as yesterday. Apologies. Who knew Steven Novella follows Canadian news?
Also please note: Dr. Novella (and others) GET ACTION. See the conclusion for recent, positive, developments.
Measles outbreaks are currently occurring around the world, and vaccine hesitancy has been named by the World Health Organization as a top threat to public health. The causes of vaccine hesitancy are multifacted, but one of the reasons may be the growing legitimization and normalization of alternative-to-medicine practitioners and practices in first world countries, where scientific literacy and credible medicine may be ignored in favour of giving legislative and regulatory approval to parallel but alternative health practices that were once called (bluntly and accurately) quackery. In Canada, alternative medicine practitioners like homeopaths, naturopaths, acupuncturists and chiropractors are licensed in many provinces, and the “remedies” they prescribe may be approved and regulated by Health Canada (Canada’s equivalent to the FDA.) Notably, many of these practices, are at their core, anti-vaccine. Given these practitioners and practices have been legitimized in the eyes of regulators, it is perhaps not surprising that organizations that fund international medical aid might not immediately see the differences between health professionals that offer science-based medicine, and practitioners of alternative medicine. It might also come as little surprise that organizations like the federal government, which has enabled and promoted pseudoscience through regulation, might be willing to support the outreach and development of these practices. The Quebec-based organization Terre Sans Frontières was recently identified by the CBC as having received $350,000 in aid money from Global Affairs Canada. Some of this funding is being used to send homeopaths to Honduras, to share homeopathic remedies and to teach homeopathy to Hondurans. This is a terrible idea, with the potential to cause lasting, harmful consequences in Honduras.
Who are Terre Sans Frontières?
Terre Sans Frontières (TSF) is a Quebec-based charity that purports to offer community development, aid, and health care to developing countries in the Caribbean, Africa, and South America. As charities go, it’s relatively small, with total revenue of about $11 million per year (2016), most of which comes from donations, with some funding from government programs. Their programs run the range of conventional to quackery, and include Optometrists Sans Frontières, Dentists Sans Frontières, Acupuncture Sans Frontières, Chiropractors Sans Frontières and Homeopaths Sans Frontières (whose page was just scrubbed). Its agenda for Honduras for 2018 was as follows:
Mandate: objectives
- Continued sharing of basic family health knowledge through homeopathy and homeoprophylaxis among students and health promoters:
- Continuing education on the following common pathologies: diarrhea, infections, coughs, fevers, trauma, etc.
- Continuous training on more chronic pathologies including high blood pressure, diabetes, fatty degeneration, etc.
- Continuing education on preventive homeopathy on the following four vector-borne diseases: Chagas disease, malaria, dengue and chikungunya.
- Follow-up of the 8 dispensaries (Teupasenti, San Juan de Flores, Opatoro / La Florida, Cane, Valle de Angeles, Omoa / Cuyamel) :
- Continuation of the first and second level homeopathic training of the professional responsible for each clinic.
- A deep introduction to homeopathy, its basic theoretical foundation and history.
- The development of homeopathy as integral, preventive and scientific medicine.
- The methodology of homeopathy.
- Continued training in duplication of homeopathic remedies.
To understand just how dangerous this outreach will be, it’s necessary to explain what homeopathy is, and how it differs from other alternative medicine practices.
Homeopathy: Dilutions of grandeur
Apologies to regular readers, who can jump to the next section.
Many think of homeopathy as a variation of herbalism. The marketing and labeling of homeopathic “remedies” encourages you to think this, describing it as a “gentle” and “natural” system of healing, and putting cryptic “30C” codes beside long Latin names. But with herbalism, at least you’re usually getting some herb. Homeopathy’s remedies contain no medicine at all – herbal, natural or otherwise. They are inert. Homeopathy is the air guitar of alternative medicine, going through the motions of medicine, without actually providing medicine. How water and sugar pills are thought to heal is based on nonsensical, prescientific ideas about biology, biochemistry, and medicine itself. Homeopathy is based on the idea that “like cures like” (which is simply a form of magical thinking) and then performing successive dilutions of substances in water. Each dilution is believed to increase, not decrease, the “potency” of the final product. And these are serious dilutions. 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 “30C” dilution you’ll see on packages. Homeopaths believe that the water molecules retain a “memory” of the original substance (while somehow forgetting all the other products it has come in contact with). The final remedy is diluted so completely that most “remedies” don’t contain a single molecule of the original substance you started with. The remedies are pure placebo with no effectiveness. Homeopathy is truly the air guitar of medicine.
Exploitation, not humanitarianism
What is TSF promoting in Honduras? Fake vaccination, known as homeoprophylaxis. From their 2017 report:
With the opening of a new homeopathic dispensary in Cane and the addition of an annex to the Padre Pedro Drouin homeopathic dispensary in Valle de Ángeles this year, together with the existing dispensaries operating in Cantarranas, Omoa, Opatoro/La Florida and Teupasenti, TSF and GAC’s homeopathic care program in Honduras is now completely centred on strengthening local skills. We engaged in three missions, with five homeopaths and three students delivering nine homeopathy courses to 46 people who work at the dispensaries or in healthcare, as well as 121 health promoters. These courses emphasized the transfer of knowledge in primary, secondary and tertiary community health services as well as prevention through homeopathy and homeoprophylaxis, i.e. the use of homeopathy to prevent epidemics. In 2017–2018, 668 people (481 women and 187 men) received preventive or curative treatment at the dispensaries.
Some translation is warranted here. In 2017-18, 668 Hondurans received inert sugar pills instead of proper medicine. Homeoprophylaxis is fake vaccination, with sugar pills, producing no immune response and no protection. Giving homeoprophylaxis means that no immunization has been given – something these Honduran patients may not even have realized. Teaching people that sugar pills can protect against infectious disease, and that homeopathy has something to offer a country in terms of health care, is not just a bad idea – it’s demonstrably dangerous, especially when the intent is to grow the practice of homeopathy. As David Shaw noted an article on the Homeopaths Without Borders movement published in the BMJ back in 2013,
Despite Homeopaths Without Borders’ claims to the contrary, “homeopathic humanitarian help” is a contradiction in terms. Although providing food, water, and solace to people in areas affected by wars and natural disasters certainly constitutes valuable humanitarian work, any homeopathic treatment deceives patients into thinking they are receiving real treatment when they are not. Furthermore, training local people as homeopaths in affected areas amounts to exploiting vulnerable people to increase the reach of homeopathy. Much as an opportunistic infection can take hold when a person’s immune system is weakened, so Homeopaths Without Borders strikes when a country is weakened by a disaster. However, infections are expunged once the immune system recovers but Homeopaths Without Borders’ methods ensure that homeopathy persists in these countries long after the initial catastrophe has passed. Homeopathy is neither helpful nor humanitarian, and to claim otherwise to the victims of disasters amounts to exploitation of those in need of genuine aid.
Defending quackery?
The CBC followed-up on its initial story, contacting the federal minister responsible for international development, who denied an interview. On March 1, they reported that the government had reaffirmed their support for homeopaths, and for this work:
“The World Health Organization and Pan American Health Organization in its 2014–2023 strategy encourage the integration of traditional medicine and complementary medicine, including homeopathy, into national health systems”.
But that argument seemed to change quickly, in an update that was published last night:
A change in policy
Did Steven Novella’s post get action? Let’s give him credit, (in addition to Vik Adhopia, who broke this story for CBC news). Yesterday the Canadian press announced:
A Quebec-based aid group offering controversial homeopathic therapies in Honduras will not receive funding from the federal government after the 2019-20 fiscal year, Global Affairs Canada said Wednesday.
And
Louis Belanger, spokesperson for International Development Minister Maryam Monsef, said the five-year funding package was signed by the previous Conservative government.
“I am unclear why the Conservatives would [sign] off on this five-year program back in 2015. … We will not be funding these types of initiatives any longer,” Belanger said.
So while the initiative has one more year of funding, let’s hope this event leads Global Affairs Canada to look more carefully at what they’re funding in the future.
Conclusion: Hondurans deserve better
Sending homeopaths to Honduras, or any other developing country, makes as much sense to a health system as offering magic carpets to passengers at an airport. That’s an imperfect analogy, as it’s quickly obvious that magic carpets really aren’t magic after all. For Hondurans being treated for infectious disease with homeopathic magic beans, and being taught that magic beans are indeed magic, the long-term harms may be more subtle and harder to spot. In this circumstance, it appears that the public scrutiny and media attention has had an effect. But as long as countries normalize practices like homeopathy, we should not expect the “Homeopaths without Borders” movement to disappear anytime soon.