In 1853 the Queen’s personal physician, Dr. John Snow dripped an ounce of chloroform on a handkerchief which was then held next to the royal mouth as Prince Leopold was delivered. Her Majesty was very happy with the experience and endorsed the use of chloroform. Many women followed suit, sometimes even naming their newborn children “Anesthesia.”
The Canadian Association of Naturopathic Doctors has recently produced several television ads featuring Naturopathic doctors sporting white lab coats and stethoscopes highlighting their apparent medical training. “True or false? Naturopathic doctors are medically trained. Of course we are. I’m a naturopathic doctor,” responds Dr. Jennifer Forgeron, as her name, along with the dubious title “ND” appear next to her on screen. Other commercials attempt to dispel the notion that Naturopathic Doctors aren’t regulated, as small text in the corner of the screen subtly notes that ND’s are currently only regulated in five provinces. The screen then fades to the slogan “Medically Trained. Naturally Focused. ™” Just like their medical training, the validity of these television spots should be seriously questioned.
While the Canadian College of Naturopathic Medicine (CCNM), one of the two accredited Naturopathic schools in Canada provides some refreshing clarity on the pre-requisite basic sciences courses, as well as medical science-based courses in the ND curriculum as far as the names of the courses go, there is a depressing drop off in information subsequently. For example, the CCNM course description for Embryology lists the following only, “Basic principles and mechanisms of human development from conception to shortly after birth are discussed. The normal development of each of the body’s systems is reviewed, and examples of how abnormal development may occur are given.” No suggested texts are offered, or qualifications of the professors are included. Compounding the concern, it is immediately striking to see that courses such as “Homeopathic Medicine I” and “Massage/Hydrotherapy” are taught alongside these more legitimate courses.
Perhaps as confusing as the slogan CAND has adopted, is the near-ubiquitous association Naturopaths have with the stethoscope. If there was one instrument that isn’t more intimately tied to a doctor, I am not aware of it. A survey of the CCNM course list shows courses such as “Physical and Clinical Diagnosis Practicum I” which offers “competence in taking a patient history and performing a physical examination efficiently and accurately…the skills necessary to conduct a thorough systems-based physical examination, interpret physical findings, elicit a complete medical history, and document the information appropriately.” This would imply training in the use of a stethoscope under the supervision of a Naturopath preceptor, which raises the concern on whether students are being taught to use the device correctly, and more importantly, what conditions are being taught to diagnose. It is difficult to make a sweeping statement about a Naturopath’s proficiency with a stethoscope, but one thing is certain – they are not cardiologists.
The ultimate demonstration of proficiency however, is successfully passing an accreditation exam. One would suspect that in order to boast about being “medically trained,” an aspiring ND should have to complete the same medical licensing exams as a Medical Doctor. This is not the case – not by a long shot. The Naturopathic Physicians Licensing Examinations (NPLEX), while similar in structure to the American USMLE and Canadian LMCC exams are fundamentally different exams. The NPLEX is consistently shorter than the LMCC and USMLE in terms of questions asked and time allotted to write, notwithstanding that it has the additional burden to testing Naturopathic in addition to the Medical content. I wonder how Naturopaths would fare writing the USMLE…
Most concerning about these videos is the underlying message that a Naturopath is sufficient on their own to treat a health issue. The saddening events surrounding the death of Ezekiel Stephan from meningitis after being misdiagnosed and treated with echinacea instead of antibiotics by a Naturopathic doctor is a reminder of the harm those claiming to have a medical training can do. Meningitis is a diagnosis that fundamentally cannot be missed, and one that is taught to medical students early on and repeatedly throughout their training.
Allopathic, or medically-trained doctors are certainly not immaculate when put under the spotlight either. It would be foolish to not suggest that some MD’s have abused their training in similar ways to ND’s, or failed to treat serious medical issues to a reasonable standard. The separation lies with the fact that medicine is a science that subjects itself to the dominion of evidence over all else. What can be proved to not be effective is discarded from the arsenal of medical science, a concept quite the contrary to naturopathy, which makes a nest from the discarded scraps of evidence-based medicine, and then calls it “alternative.”
No doubt, these videos by the Canadian Association of Naturopathic Doctors have been produced reflexively to the increasing public and media attention they have received after cases like Ezekiel Stephan. They insidiously mask that beneath the stethoscope-wielding, white-coated pseudophysician lies an organization in turmoil, struggling to increase their legitimacy and breadth of care, paying little attention to the training they provide and even less to the impact they will have.
One has to wonder then, when a Naturopathic doctor asserts to you that they are medically trained, will they point to a poster in their office, written in small hardly visible text, listing the terms and conditions?
Mary Poppins, starring Julie Andrews, was a big hit for Disney studios in 1964. The film was a musicalized version of the children’s books about a magical English nanny written between 1934 and 1988 by P.L. Travers. The movie featured a number of songs written by Robert and Richard Sherman including the catchy tune sung by Andrews with the line, “A spoonful of sugar helps the medicine go down.”
The idea for the lyrics came from a real life situation. Robert Sherman was working on ideas for a song but was drawing a blank until one day he came home and learned from his wife that his children had received a polio vaccine. Thinking that the vaccine had been a shot in the arm, he asked one of his children whether it had hurt. Not at all, the child replied. There had been no jab. A drop of liquid was placed on a sugar cube that had to be swallowed. At that moment the title for the song was born!
The oral vaccine that the Sherman children received had been developed by Albert Sabin and was introduced commercially in 1961. It used a weakened form of the polio virus that triggered the production of antibodies against the active virus. The oral version to a large extent replaced the original injectable vaccine introduced in 1955 by Jonas Salk based on an inactivated form of the virus. Thanks to these vaccines, polio has been largely eliminated from the world.
Of course, every sort of medical intervention is associated with some risk. In very rare cases, the vaccine can cause polio symptoms, but the benefits greatly outweigh any risk. Both vaccines are on the World Health Organization’s Model Lists of Essential Medicines, the most important medications needed in a basic health system. Had the vaccine been available earlier, U.S. president Franklin Roosevelt would not have contracted polio in 1921.
The spoonful of sugar in combination with a medicine may have an impact other than just pleasing our musical appetite. It seems that infants given a little bit of a sugar solution feel less pain during injections. British pediatrician Paul Heaton found that a few drops of sucrose solution put on their tongues before an injection was capable of blocking the pain felt in their arms or bottoms. He theorizes that: “The sweet taste works through nerve channels in the tongue that perceive sweetness in the brain.” The brain reacts by producing endorphins, the body’s natural pain relievers. Furthermore, in babies, sucking releases endocannabinoids that also alleviate pain. Heaton noted that once babies taste the solution, they cried less and recovered more quickly from the jab. He recommends giving babies just enough sugary solution to taste, but not enough to swallow before vaccination. Interestingly, the relationship between sweets and pain relief was first mentioned in historic Jewish texts that document baby boys being given honey before circumcision. What about adults? Well, chocolates, sweet pastries and soft drinks make for a less painful life for many people.
The Sherman brothers also composed the song that has been played more often in the world than any other. It’s a Small World After All is featured at all the Disney theme parks, an adaptation of an attraction introduced at the New York World’s Fair in 1964. The Sherman Brothers wrote the song in the wake of the 1962 Cuban Missile Crisis, which influenced the song’s message of peace and brotherhood. They also wrote a song for the Adventure Thru Inner Space attraction that was presented in Disneyland’s Tomorrowland from 1967 to 1985 designed to simulate humans shrinking to a size smaller than an atom. Visitors boarded Atommobiles and began a journey that passed through snowflakes into the inner space of molecules, then atoms. They got an idea of crystal structure, bonding between atoms and the composition of an atom. The journey was accompanied by the song Miracles from Molecules.
From the beginning until 1977, Adventure Thru Inner Space was sponsored by the Monsanto Company, which later transitioned from being a chemical manufacturer to a biotechnology firm. Founded in 1901 by John Francis Queeny and named after his wife’s family, Monsanto initially produced food additives like saccharin and vanillin before expanding into industrial chemicals such as sulphuric acid and PCBs in the 1920s. By the 1940s, it was a major producer of plastics, including polystyrene, as well as a variety of synthetic fibres. Monsanto scientists had a number of notable achievements, like the development of “catalytic asymmetric hydrogenation,” that made possible the production of L-Dopa, the major drug used in the treatment of Parkinson’s disease. They also laid the foundation for the mass production of the light emitting diodes (LEDs) that have revolutionized the lighting industry.
Monsanto has been criticized for once manufacturing such controversial products as the insecticide DDT, PCBs used as insulators in electronic equipment and the notorious Agent Orange that was widely deployed as a defoliant during the Vietnam War. At the time, DDT and PCBs solved immediate problems, with DDT saving millions of people from contracting malaria and PCBs in transformers making electricity widely available. The environmental issues that eventually emerged concerning these chemicals were not, and probably could not have been foreseen at the time.
Today, most people associate Monsanto with genetic modification and the company serves as a lightning rod for anti-GMO activists. Indeed Monsanto was among the first to genetically modify a plant cell and one of the first to conduct field trials of genetically modified crops and now markets canola, soy, corn and sugar beet seeds that yield plants capable of resisting herbicides and warding off insects.
Let me end with a stanza from the Sherman brothers’ song Miracles from Molecules that once captivated visitors to Disneyland and which I believe is still meaningful today:
Now Men with dreams are furthering,
What Nature first began,
Making modern miracles,
From molecules, for Man
Dr. Joe Schwarcz
“Is it true that putting a piece of garlic in the rectum at night can cleanse the body?”
And with that single question posed by an audience member back in 1975, my chemical focus shifted to food and nutrition. The question came after one of my first public talks on chemistry at a local library, where I had described the role chemistry plays in our daily lives, mostly using dyes, drugs, plastics and cosmetics as examples.
I was sort of taken aback by the question, but managed to stammer something like “where did you hear that?”
Back came the answer, “from Panic in the Pantry.” After mentioning that my only experience with garlic had been with rubbing it on toast with some very satisfying results to the palate, I promised to check out the reference.
It wasn’t hard to track down Panic in the Pantry in a local bookstore. The title had suggested some sort of attack on our food system, but this turned out not to be the case. At least not in the way I had thought. Flipping through the book I came across terms like “chemophobia,” “carcinogen,” “additives,” “chemical-free” and “health foods.” I was intrigued, especially on noting that the book had had been written by Frederick Stare, a physician with a previous degree in chemistry who had founded the Department of Nutrition at Harvard’s School of Public Health, and co-author Elizabeth Whelan. Within a day I had read Panic in the Pantry from cover to cover and was so captivated that I dove into the turbid waters of nutrition and food chemistry with great enthusiasm. Ever since then, I have been trying to keep my head above water, buffeted by the growing waves of information and misinformation.
Panic in the Pantry focused on what the authors believed were unrealistic worries about our food supply, vigorously attacking the popular lay notion that “if you can’t pronounce it, it must be harmful.” Yes, that daft message was around long before the Food Babe made it her anthem. In truth, the risks and benefits of a chemical are a consequence of its molecular structure, and are determined by appropriate studies, not by the number of syllables in its name. Stare and Whelan also challenged the “Delaney Clause,” a piece of U.S. legislation stating that no additive shall be deemed safe if it has been shown to cause cancer in any species upon any type of exposure. They pointed at studies that showed very different effects of chemicals in rodents and humans and maintained that it was unrealistic to condemn additives if exposure was not taken into account. “Too much sun can cause skin cancer, but does that mean we should stay indoors all the time?” they asked.
What about the curious case of the clove of garlic in the rectum? An excellent example of a misinterpretation of information, something that I have seen much too often. In a discussion of food faddism through the ages, the authors introduced the antics of one Adolphus Hohensee, who had forged a career as a “health food” advocate after his real estate business had landed him in jail for mail fraud. The dietary guru told his audiences that the sex act should last an hour, and if they did not measure up to this level of sexual adequacy it was because they had a diet laden with additives.
Hohensee’s answer to the chemical onslaught was a clove of garlic in the rectum at night, with proof of its efficacy being the scent of garlic on the breath in the morning. Obviously, the garlic had worked its way from bottom to top, cleansing everything in-between. Far from promoting this regimen, Stare and Whelan had used it to highlight the extent of nutritional quackery.
I found most of the arguments in Panic in the Pantry highly palatable, but there was a discussion of one chemical that left a somewhat bitter taste. That chemical was sugar. I had been quite taken by Pure, White and Deadly, a 1972 book by British physiologist John Yudkin, who made a compelling case linking sugar to heart disease, cavities, diabetes, obesity and possibly some cancers. Stare dismissed sugar as a culprit, implicating saturated fats as the cause of coronary disease. That to me seemed not to meet the standard of evidence that was applied to other issues in Panic in the Pantry.
As it turns out, there was a reason for Stare’s dismissal of sugar as a health problem. In 1965, the Sugar Research Foundation (SRF), the industry’s trade association, asked Stare to sit on its advisory board because of his expertise in the dietary causes of heart disease. The sugar industry was extremely worried about Yudkin’s growing influence and decided to embark on a major program to take the focus off sugar and direct it toward fats. Stare’s defence of sugar as a quick energy food that should be put in coffee or tea several times a day and calling Coca Cola a healthy between meals snack was welcomed by the industry.
As we have now learned from historical documents brought to light in a paper in the Journal of the American Medical Association, the SRF paid members of Stare’s department to carry out a literature review, overseen by Stare, designed to point a finger at fats while expressing skepticism about sugar’s supposed criminality. That review was published in the New England Journal of Medicine without any disclosure of sugar industry funding and successfully steered readers away from associating sugar with heart disease. While Stare, who died in 2002, was correct about many aspects of unfounded chemophobia, his reputation has now been tarnished by the undeclared payments received by his department from the sugar industry.
Sugar, as we now know, is not as innocent as Stare had claimed. But at least he never did suggest garlic in the rectum to cleanse toxins. As far as I know, neither has the Food Babe.
Dr. Joe Schwarcz PhD