We saw it coming. The re-emergence of vaccine-preventable disease should surprise no-one that’s been following the anti-vaccine movement.
Rebutting anti-vaccine rhetoric feels like a Sisyphean struggle. Steven Novella likened it to a game of whack-a-mole, where the moles are the same old tropes that keep popping up, no matter how often they are refuted with facts. Vaccines are a remarkable success of modern medicine: They are health interventions that are both demonstrably effective and remarkably cost-effective. Vaccination has likely prevented more deaths in the past 50 years than any other health intervention. Smallpox was a ruthless killer that took 300 million lives, just in the 20th century alone. Today it’s gone – eliminated forever. And now there are now over two dozen diseases that are vaccine-preventable. They should be an easy sell, and to most people, they are. But the control of vaccine-preventable disease relies in part on herd immunity – sufficient immunization to stop the spread of infection (no vaccine offers 100% protection) and protect those that cannot be immunized. Even a modest number of unvaccinated individuals can lead to reemergence of disease. None of this matters to antivaccinationists, to whom vaccines are bad. Viewing anti-vaccine websites for only five to ten minutes can increase the perception of risk of vaccination, and decrease the perceived risk of omitting vaccines. It also lowers vaccination intentions. By changing perceptions of safety, the willingness to vaccinate decreases. Now imagine that someone you believe to be a health professional openly questioned the efficacy and safety of vaccines – would it reduce your willingness to vaccinate? The evidence says it does. And that’s why the modern practice of naturopathy or “naturopathic medicine” is so concerning. Naturopaths have opposed vaccinations since the invention of naturopathy – starting with smallpox:
To understand how revolting these products are, let us just refer to the vaccine matter which is supposed to be an efficient preventive of smallpox. Who would be fool enough to swallow the putrid pus and corruption scraped from the foulest sores of smallpox that has been implanted in the body of a calf?…The natural system for curing disease is based on a return to nature in regulating the diet, breathing, exercising, bathing and the employment of various forces to eliminate the poisonous products in the system, and so raise the vitality of the patient to a proper standard of health. Official medicine has in all ages simply attacked the symptoms of disease without paying attention to the causes thereof, but natural healing is concerned far more with removing the causes of disease, than merely curing its symptoms.
Benedict Lust, who introduced naturopathy in the United States, made the statement above in 1918, in his Universal Directory of Naturopathy. You’ll hear similar sentiments from naturopaths today. Lust introduced the core tenets of the naturopathic philosophy: natural is better; vaccines are unnatural (and therefore bad); we’re being poisoned from within (i.e., detox); and naturopaths treat “root causes” while physicians don’t. None are science-based ideas – they’re actually derived from the concept of vitalism, a pre-scientific belief that biological organisms are fundamentally different that non-biologic organisms. Today naturopaths call it the “vital force” but the meaning is the same. Naturopathic treatment ideas are grounded in the belief that they are restoring the vital force, rather than being based on objective science. The practice itself has evolved into a mix of disproven or unproven health practices including homeopathy, acupuncture and herbalism. Pretty much anything goes, as long as it aligns with the vitalistic belief system. Naturopaths can give good health advice – much of the basic dietary advice they offer is sound. Yet this isn’t a position arrived to because of the evidence, but rather despite it: The philosophy and the science just happen to align.
Immunization is strongly science-based and there’s an established track record of effectiveness and safety with population-based immunization programs. While individual attitudes can vary, science-based health professionals, working from a common scientific framework, generally accept the science of immunization. In contrast, alternative-to-medicine practitioners like homeopaths, chiropractors, and particularly naturopaths remain hostile to vaccinations, despite the impressive track record of successes. This sentiment, and its effects, have been consistently documented in in the medical literature:
- The longer naturopaths are in naturopathy school, the less supportive they become of vaccines. One survey of naturopathy students found only 12.8% were supportive of the full pediatric vaccination schedule.
- Care from a naturopath is associated with fewer vaccinations and a greater likelihood of vaccine preventable disease.
- A survey of Massachusetts naturopaths and homeopaths noted that most did not recommend vaccination.
- A survey of children’s records from an Ontario naturopathic clinic identified 8.9% of children had not been vaccinated.
Despite the antagonism naturopaths hold towards vaccination, they also appear to understand that their philosophy is strongly anti-scientific. Given naturopaths repeatedly describe naturopathy as a science-based profession, they tend to be subtle with their objections – often cloaking their personal antagonism with discussions of “personal choice” or fabricating a “both sides” argument, sidestepping the reality that there are no substantive science-based objections to immunization. A perfect example of this are the recent remarks from the president of the College of Naturopathic Doctors of Alberta, Allissa Gaul, who gave a thinly-veiled antivaccine message in a recent CBC interview:
Gaul was asked to explain the antivaccine advertising and statements coming from Alberta naturopaths. The concern is justified, given Alberta is currently dealing with a measles and a whooping cough outbreak. It’s worth a listen, if only to hear Gaul repeatedly refuse to offer a statement of support for vaccination, while also denying that naturopaths are anti-vaccine:
“As a College we don’t have a direct policy… My personal opinion as a doctor is that people should do their due diligence and make the choice that’s best for them … I think it’s a grey issue because it’s an issue about children and about health and about parents’ choices and that in this country, of course, we have the choice to vaccinate or not and so, people interpret that as if they have the choice to vaccinate or not.”
And later in the interview:
“The naturopathic doctors in the province should also be supporting those who are against [vaccinations]… If somebody chooses not to vaccinate, they should also have a support person behind them. That doesn’t mean that that person should be telling them what to do.”
In response to the link between autism and vaccines, and Alberta naturopaths linking the two, Gaul spins this to link vaccines with atopic disease (another relationship that’s been refuted).
Off the radio, Gaul is more direct with her personal opinions on vaccination. She thinks influenza infections are a pretty good idea:
We live in a sea of germs that we co-exist with peacefully for the most part, including influenza viruses. To me, an acute illness often represents either a weakening of a person’s resources, and/or an opportunity for growth and development. In kids, this is way more obvious — following infectious illness, you often see developmental milestones appear! In adults, of course, this is not as obvious. Having the flu could improve your thought process and maturation. Keep open to the possibility for positive change! An adult should have a nice, juicy infection every 3 or 4 years. This is a good indicator of a healthy immune response (I’d be more worried if you DIDN’T get sick).
Yes, you read that correctly – she’s supportive of influenza infections, one of the most astonishing statements I’ve ever seen from a naturopath. Hopefully that “growth and development” virus doesn’t kill you. So what does Gaul (who, remember, is the President of the College of Naturopathic Doctors of Alberta) recommend to treat influenza infections once you’re lucky enough to become infected? Useless nostrums: vitamins, aromatherapy, and unbelievably, even fake vaccines called “homeopathic nosodes”:
The Influenzinum nosode has been working quite well in suspected cases of H1N1, as has Oscillococcinium and some of the other common flu remedies. Take a dose of your selected homeopathic once per day if you feel you are being exposed and once every few hours if you feel the onset of flu-like symptoms. If you don’t have much exposure you can take a immune-boosting dose weekly up to monthly, depending on how great you feel your risk is.
A homeopathic nosode is made from bodily tissues and fluids (such as feces, blood and pus) from a patient suffering an infectious diesease. This material is then sterilized and serially diluted, repeatedly, until (just like other homeopathic products) there is no trace of the original active material. Homeopaths and naturopaths believe that nosodes provide immunity against infectious disease – when they are actually just inert placebos, with zero evidence of efficacy. Gaul also sells homeopathic remedies directly from her website. All of this leaves me asking: If the president of the College of Naturopathic Doctors of Alberta is pro-infectious disease, and endorses fake vaccines for treating influenza infections, what does that say about the standard of care offered by naturopaths in Alberta?
Is the naturopathic standard of care antivaccine?
It would be easy to find more statements from naturopaths who share anti-vaccine philosophies with Gaul. But beyond the College of Naturopathic Doctors of Alberta, what do other naturopathy organization and publications say about vaccination today?
- A perusal of the vaccine resources made available by the Canadian College of Naturopathic Medicine includes references like What your doctor may not tell you about children’s vaccinations and Homeopathic Prophylaxis: the vaccination alternative.
- The teaching clinic of Bastyr University claims that influenza vaccines weaken the immune system, and the vaccine isn’t recommended if you’re healthy. Bastyr also recommends this book on vaccinations for parents, written by a herbalist which claims to examine “both sides” to the vaccination issue. Notably absent on the Bastyr website are any references to the CDC.
- Bastyr sells fake homeopathic vaccines, including a fake “MMR” vaccine as well as homeopathic nosodes like Influenzinum.
The British Columbia Naturopathic Association Vaccination Position Paper sows doubt about the safety and efficacy of vaccination while professing that they want to “individualize” treatment:
If there are general concerns regarding vaccinations they can perhaps be summarized as focusing on toxic preservatives (and their side effects), the “unnatural” route of entry and the possible contamination of vaccines. Naturopathic physicians (NDs) feel these are legitimate concerns. Given the contentious nature surrounding the subject of vaccinations, the NDs in this province support informed consent as a useful approach to dealing with vaccination protocols.
It also makes erroneous comments about thimerosal, a vaccine preservative, again raising doubt about the safety profile:
Many Vaccinations Contain Potentially Toxic Preservatives such as Thimerosal
Most children in BC receive combination vaccines so their total exposure to preservatives is relatively low. However, in cases where infants receive individual vaccines preserved in thimerosal their total exposure to methyl mercury (thimerosal) can exceed safe limits. Also, animal studies have demonstrated that thimerosal can induce hypersensitivity reactions and may augment many vaccine side effects.
The paper concludes with a commitment to “informed consent” which could be more accurately called “misinformed consent” given the misleading statements provided:
The decision a parent takes to proceed with or withdraw their children from the vaccination schedule is a personal one, which can be characterized as informed consent.
The Oregon Association of Naturopathic Physicans’ White Paper gives similar messaging:
Naturopathic doctors are educated according to the public health laws of the state, and understand the role that vaccinations play in preventing communicable disease. But because naturopathic care is by definition patient centered, many NDs will customize the vaccination schedule to address the patient’s risk factors, environment, and personal beliefs.
The evidence is very clear on what naturopaths mean when they say “customize” – they mean fewer vaccinations and consequently, more preventable disease.
Sussanna Czeranko, an Ontario and Oregon naturopath, in her multi-part article “The Persistent Question of Vaccination” published in The Naturopathic Doctor News and Review notes:
When vaccination came onto the medical sphere, to say that the earth opened and swallowed up common sense and human dignity is an understatement. The core principles that differentiated the distinct schools of medicine at the time were tested in ways that we still see remnants of today. The ‘regular’ and ‘irregular’ medical camps became contentious factions which aligned firmly and decisively on either side of the debate when vaccinations became part of the medical toolkit. The doctors who supported vaccination had much to gain from its clinical employment and the doctors who opposed its use had to endure hard lessons that persist in today’s medical landscape.
Medical doctors and naturopathic doctors banded together and took a stand against vaccinations. Vaccinations became an issue that galvanized each faction. The vaccinationists became politicized, rich and kept their patients in ignorance. The anti-vaccinationists educated their communities and practiced with nature’s laws. The naturopathic profession has yet to clarify or even unify its position on the issue in the closing days of the first decade of the new century. We may well as a profession find ourselves nodding in agreement with Hodge, who stated in 1911, “the amazing fact that it has been possible to force the vaccination atrocity upon the unconsenting world for more than a century is almost incomprehensible.”
Vaccine opposition is intrinsic to the naturopathic philosophy, is embedded within naturopathic education, and now appears to be a standard of practice for the profession, based on recent comments from the Alberta College of Naturopathic Medicine. Naturopaths claim to be primary care providers, and repeatedly tout their supposed “integrated” and “patient-centered” approach to care. Yet the facts illustrate that what naturopaths seem to be integrating are vaccine-hostile attitudes and unscientific (and possibly dangerous) ideas about the prevention and treatment of preventable disease. As regulators seem content to grant legitimacy to naturopathy as a health profession, we should continue to expect ongoing challenges to the control and eradication of vaccine-preventable disease.