Alberta Government Should Approach "Alternative Medicine" With Trepidation

My latest Calgary Herald column looks at the Alberta government's recent decision to regulate naturopaths:

It's commendable that Health Minister Fred Horne wishes to respect choice in health care.
However, acknowledging that various health options exist need not lead to an endorsement - tacit or otherwise - of those options.
Last week, the Alberta government announced changes to the Health Professionals Act to officially recognize naturopaths and to establish the College of Naturopathic Doctors of Alberta. The changes also spell out which procedures naturopaths are licensed to perform.
The government's news release pledges that "Albertans can be assured they are receiving safe, effective services from qualified professionals."
It also offers a definition of naturopathy that could have been written by the industry itself: "focus(es) on health promotion, illness prevention and treating disease using natural therapies and substances that promote the body's ability to heal."
However, this branch of so-called alternative medicine is viewed with much apprehension by those who adhere to a belief in evidence-based medicine.
For example, Dr. Kimball Atwood, an assistant clinical professor at the Tufts University School of Medicine in Boston and associate editor of the Scientific Review of Alternative Medicine, says naturopathy stems from a 19th-century health movement espousing "the healing power of nature."
He writes that present-day naturopathy is "replete with pseudo-scientific, ineffective, unethical and potentially dangerous practices."
At some level, the Alberta government concurs, because the health system does not cover naturopathic services or treatments, and the government made it clear that the status quo in that regard is not changing.
Therefore, the government's position appears contradictory. If indeed naturopaths offer "safe and effective" treatment, then why wouldn't they be covered? However, if these services do not meet the evidentiary standard laid out by our health-care system, then why is the government giving what surely amounts to tacit approval of naturopathy?
The health minister has a broader duty, I dare say, to uphold the integrity of the health-care system and to ensure that his department's decisions are doing nothing to undermine important public health initiatives.
Take, for example, the importance of vaccines. Alberta Health Services has been advancing this cause on a number of fronts recently, with respect to pertussis, HPV and chickenpox. The AHS website devotes an ample amount of space to providing information about the importance of vaccination and some of the myths around vaccines.
A study last year from researchers in Toronto found that parents who rely primarily on naturopaths were more likely to have a partially vaccinated or unvaccinated child. Do we now risk exacerbating this problem here in Alberta?
Vaccination is a choice, just as visiting a naturopath is, but it serves to illustrate how the Alberta government can respect the existence of choice, while at the same time taking a stance in favour of the scientific evidence.
To speak of "traditional medicine" and "alternative medicine" is to offer a meaningless and useless distinction. The only distinction that ought to concern us is the distinction between that which works (medicine) and that which does not (hooey).
A recent study by University of Alberta researchers Tim Caulfield and Christen Rachul found that naturopaths in Alberta and B.C. are regularly offering services that are "of questionable value and have no scientific evidence of efficacy beyond placebo."
Those include chelation therapy, colon cleanses and homeopathy.
Homeopathy, which posits that "like cures like" and the more diluted a substance, the more powerful it is, may be shunned by some naturopaths, but all are trained in it. Even the website of the Canadian Association of Naturopathic Doctors lists homeopathy as an example of a naturopathic treatment.
If naturopaths are offering treatments with little or no scientific basis, it seems to me that rather than weeding out such practices, the Alberta government's decision only further entrenches them and ensures more Albertans receive them.
Homeopathy, for example, may be "safe" in the sense that there's nothing in it to cause harm, but the danger arises when unsound practices becomes a substitute for medically sound and medically proven treatments.
The Alberta government may have a role to play in ensuring the safety of so-called alternative health products and services, but it should be careful about not undermining the health-care system in the process.

More Evidence on the Failings of Distracted Driving Laws

My latest Calgary Herald column looks at the latest evidence on the ineffectiveness of distracted driving laws, and what it tells us about bad policy and government promises:

While there's often an expectation on government to devise a policy to address a certain problem, the mere creation of the policy does not mean the problem has been solved.   Were that the case, the distinction between good and bad policy would be meaningless.
One can therefore oppose a specific policy and still share the concern about the problem that the policy is ostensibly designed to fix.   That may seem reasonable on paper, but it is not always recognized in practice. Often, opponents of a policy are accused of being indifferent to the problem, or even opposed to it being solved.
For example, a desire to reduce gun-related homicides was the impetus for creating the national long-gun registry. However, a study published last October in the Journal of Interpersonal Violence demonstrated quite conclusively that the registry had no significant bearing on Canada's homicide rate.
Despite those findings, there was - and continues to be - much maligning of gun registry opponents and their purported intransigence to taking steps to save lives.
Here in Alberta, we saw something similar with the debate around Bill 16, the government's so-called solution to the problem of distracted driving. The law passed in November 2010 and officially took effect in September 2011.
Many legitimate questions were raised about the failings of similar laws elsewhere and the absurd provisions of Bill 16 (for example, texting or talking in a drive-thru lineup or while stopped at a train crossing constitute distracted driving), but the government merely declared that it was "making roads safer," and therefore opponents of the bill were obstacles to that end.
We've not yet reached a full year of the law being in effect, but already we have evidence pointing to its failings.
Calgary police report that the number of distracted driving tickets they are issuing continues to rise.  That might be considered a success if the goal is to raise revenue, but it is hardly something to celebrate if the goal is to change behaviours and make roads safer. Last October, 416 tickets were issued. The number dropped the following month, but was back up to 529 for April.
And while it's still early days here in Alberta, a new review of the experience in Manitoba thus far gives us even more cause for concern.
Manitoba's distracted driving law took effect in the middle of 2010, so there's now more than a full year of data to examine, which is exactly what a new study from the Frontier Centre for Public Policy does.
The report finds that highway collisions in 2011 had increased to above the total for 2009, despite the fact that highway crashes involving speed and alcohol decreased during that time.
These results would appear to confirm what other studies have found about the ineffectiveness of distracted driving laws.
Earlier this year, the Swedish National Road and Transport Institute concluded in a report done for the Swedish government that there is no basis for a legislated ban.   Last year, the Governors Highway Safety Association in the U.S. released a study that analyzed more than 350 scientific papers on distracted driving. They found that there is really no evidence suggesting these bans actually work. The association is now urging states to hold off on such laws.
A study released in 2010 by the U.S. Highway Loss Data Institute found that states with cellphone bans saw no decrease in crashes compared to states with no bans. Another study found the same for states with bans on texting while driving - three of the four states with such bans actually saw increases in crashes among young drivers.
Researchers suspect drivers are holding their devices low to avoid detection, therefore making their behaviour even more dangerous.
None of this is to suggest that people should be texting while driving, or that there aren't ways of discouraging such behaviour.   Rather, it's an illustration of how empty political assurances are without evidence to back them up. Simply declaring you're going to make the roads safer does not automatically mean that you are.
It's something to bear in mind as the government's new impaired driving law begins taking effect - a law sold to Albertans with similar unequivocal assurances.

Bishop Henry is Undermining the Very System He's Trying to Defend

My latest Calgary Herald column looks at Calgary Bishop Fred Henry and his intransigence over allowing the HPV vaccine to be administered in Calgary Catholic schools:

Calgary Bishop Fred Henry seems convinced that he’s in a battle to save Catholic education, but his quixotic quest may instead prove to be destructive to his cause.
As someone who has declared himself to be mandated to speak authoritatively on moral issues, Henry is doing his utmost to ensure his views are regarded as irrational. In the process, he is undermining the cause for publicly funded Catholic education.
Henry is digging in his heels on his opposition to the human papilloma virus (HPV) vaccine, amid increasing pressure on Calgary Catholic schools to allow the vaccine to be administered alongside the other vaccines given to children.
Last week, a coalition of public health experts and concerned parents went public with their campaign to convince Catholic school trustees, and Henry himself, to reconsider their stance.
In Alberta, Grade 5 students receive a hepatitis B vaccine, plus the HPV vaccine. Grade 9 students get a meningitis vaccine and a diphtheria-tetanus-pertussis-polio booster shot. Parents still have the final say as to whether their children are vaccinated.
Offering vaccines in school has proven to be an efficient way of ensuring high immunization rates. One would be hard-pressed to find examples in our health-care system where efficiency and effectiveness are hallmarks, but the immunization of children would certainly seem to fit the bill.
The HPV vaccine was added to the immunization schedule in 2008. It’s estimated that over 70 per cent of Canadians will have at least one HPV infection in their lifetime. Certain types of HPV infections are responsible for virtually all cases of cervical cancer, which claims over 400 lives each year in this country.
HPV is transmitted sexually. To Henry, that makes this a moral issue, and he is stridently opposed to the vaccine being administered in Catholic schools.
Most other Catholic schools boards have decided to allow the vaccine, including Edmonton’s. In Calgary, Catholic school trustees have simply deferred to Henry — he says “no,” so they say “no.”
It certainly calls into question the point of electing these trustees, or even having them in the first place. If, for all intents and purposes, Henry is calling the shots, why not formalize that?
Henry, though, isn’t content to just have Calgary’s trustees under his thumb — he’s trying to intimidate Edmonton Catholic trustees into reversing their position, suggesting they’re “offside” in their interpretation of doctrine.
It’s worth noting the discrepancy in vaccination rates between the two jurisdictions — in Edmonton, it’s approximately 70 per cent, while in Calgary the number is less than 20 per cent.
But Henry is not concerned about vaccination rates, or apparently even about rates of HPV infection and cervical cancer.
In an interview last week, Henry declared his only concern is the church’s teachings on sexuality, and if people ignore those teachings then “there are consequences and they have to acknowledge that.”
It’s much like arguing that to teach young people to drive safely, we must remove seatbelts and airbags so they will fear the consequences of ignoring their lessons.
Such a stance ignores the circumstances beyond the individual’s control. With HPV, even if a woman saves herself for marriage, her husband could be carrying the virus. Young women can also be exposed to HPV through unwanted sexual contact.
Rather than viewing the vaccine as protection, Henry seems to view it instead as a licence to promiscuity.
The evidence supports the vaccine’s safety and efficacy — it also shows that the vaccine does not lead to promiscuity. In fact, the vaccine makes young women more acutely aware of the risks involved in having sex.
Henry’s stance is not only at odds with the evidence, it is at odds with common sense.
The more he touts that position, the more he reminds the rest of us that this irrationality is being foisted upon the duly elected representatives entrusted with administering a publicly funded school district.
Henry may indeed be spoiling for a fight on this, but perhaps he should be careful what he wishes for.