Naturopathic pediatrics is not safe


Naturopathic practitioners should be banned from treating minors.

I recently made this proposal in the context of the tragic death of Ezekiel Stephan, whose parents are on trial in Alberta for failing to provide the necessities of life. Ezekiel’s parents needlessly caused him to suffer from bacterial meningitis, in part by getting care from a licensed naturopath, Tracy Tannis, ND.

In the trial, Tannis and one of her staff members have given conflicting testimonies about their interactions with Ezekiel and his parents. It is not clear if Tannis urged Ezekiel’s parents to immediately take him to the emergency room, but it is clear that she dispensed a tincture containing echinacea to Ezekiel’s mother to treat meningitis. In fact, the physician’s report from the emergency room at Alberta Children’s Hospital supports this point.

Tannis’s recommendations were dangerously contradictory. On the one hand, Tannis claims to have urged Ezekiel’s mom to seek emergency care, but at the same time, she suggested something like, “This herbal product BLAST can help.” In selling a concoction to treat meningitis, Tannis diluted whatever medical urgency she claimed to convey.

The story of Ezekiel Stephan highlights the ethical and legal tragedies that licensed naturopaths bring to society. Licensed naturopaths themselves and legislators who affirm licensure do not realize that naturopathic training is nothing like legitimate medical school training.

I have written about the poor training of licensed naturopaths in general, but I have yet to detail the fatally flawed pediatric training that NDs receive in their accredited programs. I graduated from Bastyr University in 2011 and took every pediatrics course offered at the time. I went on to complete a one-year residency focused on pediatrics in a private naturopathic clinic. If I hadn’t walked away from being a naturopath, I would now be eligible for “board certification” in naturopathic pediatrics, yet another misleading status. Practically, however, any licensed naturopath can claim to specialize in pediatrics.

My experience puts me in a unique position to show what naturopathic training looks like from the inside and why, especially for children, naturopathic care is dangerous. In addition to my residency patient logs, I support this point with a critical review of pediatrics syllabi from Bastyr University (Seattle, WA) and Southwest College of Naturopathic Medicine (Phoenix, AZ). I then asked some pediatricians in the U.S. and Canada about their training and thoughts on my training.

Naturopathic pediatrics training by the numbers

At Bastyr, I took pediatrics 1 and 2 (NM 7314 and 7315) and an additional elective course in “advanced pediatrics” (NM 9316) from 2010-2011. I also opted to take the elective pediatrics clinical shift at Bastyr’s outpatient teaching clinic. Only pediatrics 1 and 2 were required for graduation. Each class met for 2 hours per week for 10 weeks, not including the 11th week for a final exam. By taking the advanced course, I received a total of 60 hours, but remember, only 40 hours was required. (In the year after I graduated from Bastyr, the curriculum changed to a systems-based program, which folded pediatric instruction into courses linked by medical theme.)

Bastyr NM 7314 pediatrics 1 syllabus page1

For comparison, at Southwest College of Naturopathic Medicine (SCNM), in 2007, students were required to take one pediatrics course (CLSC 764) for 3 credits that met for 3 hours per week for 9 weeks. (I am not counting the class meeting for the final week that were scheduled for the exam.) At SCNM, a naturopathic student was required to take 30 hours of pediatrics.

Screenshot 2016-04-16 15.17.25

It is important to note that accredited naturopathic programs do not have clinical rotations built into pediatrics courses, or into any clinical science course for that matter. Naturopathic students get a mere total of 850 hours of clinical training on about 400 patients in outpatient clinics run by naturopathic programs. In fact, it is entirely possible that a naturopathic student could graduate without seeing any pediatric patients.

I was one of the few to take the elective clinical shift dedicated to pediatrics, but by no means would I call this shift “busy.” I didn’t see any newborns. We talked to parents about what supplements to take in order to “boost the immune system.” We counseled about alternative vaccine schedules and didn’t actually give out vaccines. What kind of primary care training is this?

Bonafide medical programs provide their students with no more than 80 hours per week of pediatrics rotations over eight weeks in real hospital settings and outpatient clinics where they see many thousands of patients. Medical students get up to 640 hours of pediatric clinical training in addition to dedicated pediatric lectures, seminars, grand rounds, and other sessions throughout the week. Obviously, naturopathic training pales by comparison.

Naturopathic pediatrics residency

After I graduated Bastyr, I did a one-year residency at an outpatient naturopathic practice. I chose to do this option. Most of my colleagues went directly into private practice, and some were hired as clinical instructors. (I also had a part-time job teaching first-year Bastyr students how to do physical exams.) My residency schedule consisted of seeing patients of all ages, “from newborns to grandparents”, for 26 hours per week. According to my residency patient log, for one year I saw the following number of the following types of pediatric cases:

  • Otitis media: observed (34); direct patient care (36)
  • Upper respiratory infections: observed (40); direct patient care (37)
  • Viral exanthems: observed (0); direct patient care (13)
  • Urinary tract infections: observed (0); direct patient care (3)

For comparison, I had 30 direct patient cases of food allergies, often based on dubious IgG “food intolerance” tests. The time in my residency added up to no more than 1,300 hours, which I think is vastly overestimated.

Here are scans of my residency patient log and completion certificate:

Screen Shot 2016-04-16 at 3.41.04 PM
Front matter of my residency log. Click to enlarge.
Pediatrics portion of my residency log. DPC = direct patient care; OBS = observed. Click to enlarge.
Urgent/Emergency medicine residency log. Click to enlarge.
Urgent/Emergency medicine portion of my residency log.  DPC = direct patient care; OBS = observed. Click to enlarge.
My official certificate of residency. Click to enlarge.

To provide comparative context for my naturopathic training, I asked several pediatricians I am connected with on Twitter to briefly describe their residency training. Dr. Justin Smith, pediatrician in Lewsville, TX, pointed me to an article he wrote comparing the training of chiropractors and pediatricians. He describes his training thusly:

After medical school, a pediatrician completes a three-year residency program where they participate in the care of children full time. Over those three years, pediatric residents gain experience and are given increasing opportunities to make direct treatment decisions. During this time, they participate in (at least) daily case presentations, lectures and other learning opportunities. Even at a very underestimated six hours of lecture per week, that totals more than 900 hours of lectures training in the three-year period. In addition, the hands-on and in-the-moment teaching working with patients totals about 7,500-9,000 hours (estimating 10 hours days for 5-6 days per week).

Dr. Daniel Flanders, a pediatrician in Toronto, further reiterated the high level of training that medical doctors receive in order to practice as a pediatrician:

I conservatively calculated my training out to be ten thousand hours of medical school and another ten thousand plus hours of pediatric residency.

Here’s the bottom line: a pediatrician gets a combined 20,000 hours of training in medical school and residency; a licensed naturopath has the option of doing a naturopathic residency for 1,300 hours after having done 30 to 40 hours of lecture hours in pediatrics. That difference speaks for itself. The American Academy of Family Physicians has recognized this stark contrast for years.

I know from talking to my former colleagues that most naturopaths go out to practice with almost no experience in treating children. Honestly, there’s no need to even count up the naturopathic hours because the quality of the content covered is just too different from a reality-based curriculum.

Naturopathic pediatrics training by the content

Alternative medicine programs tend to use “credit hours” as the unit of comparison with legitimate medical programs. Chiropractic programs are known for this trick, and naturopathic schools are no exception. Let’s be real, comparing hours is an ineffective way to assess the quality of a medical education because a curriculum’s true value is a measure of the details taught and experiences provided through clinical training and class meetings.

For readers to understand what is taught in a naturopathic pediatrics course, I decided to post one of my syllabi from Bastyr’s “Pediatrics 1” (NM 7314):

Click here if the viewer does not load.

It’s worth a read.

A serious concern with this course syllabus is the book list. Current and Nelson’s Pediatrics are considered standard texts, but these were not even required to read in order to do well in the course. I didn’t buy either book and didn’t complete any of the assigned readings but passed with flying colors.

It should be appalling for anyone to see Dana Ullman’s Homeopathy for Children and Infants and Dr. Bob Sears’s The Vaccine Book, not once, but twice in the list! All of my syllabi for the Bastyr pediatrics courses included these texts. The syllabus for pediatrics at SCNM does not, but its instructor, Matthew Baral, ND, is a known promoter of vaccine myths.

Indeed, Dr. Nathan Boonstra, said that “no respectable medical school would inflict those books on their students, if they actually wanted them to know how to take care of children.”

In fact, lectures conveyed the material in these books. My class notes contain clinical pearls on using homeopathic remedies to treat febrile seizures, ear infections, burns, and snake bites. One of my class notes even contains the makings for a naturopathic first aid kit using herbal and homeopathic preparations:

Naturopathic pediatrics first aid kit

While the pediatrics courses discussed vaccines and official immunization schedules, this was always in the context of stirring controversy. Take, for example, the following class note I made about counseling parents on alternative vaccine schedules:

When discussing vaccination with parents these questions need to be discussed separately:Which ones to give?When to give chosen immunizations?How many doses are recommended? Advise parents to ask the following questions in order to assist them in making the choice to vaccinate or to refuse to vaccinate:What is the seriousness of the disease?What is the risk of getting the disease?How easy is the disease to treat?What is the risk of vaccinating for the disease?How do vaccines affect our immune systems?How does exposure to childhood disease affect our immune systems?What is the general health of my child?What will my child be exposed to?If my child were to get sick because we didn’t vaccinate him how would we feel?If my child were to get sick from a vaccine how would we feel?

Naturopathic students are essentially trained in alternative vaccines schedules, which lead parents to not vaccinate. If this isn’t smoking gun proof that naturopaths are anti-vaccine to the core, then what is? I noticed that missing from my notes are discussions about how to advocate for the official vaccination schedule and alleviate parental fear of toxins, for example.

In one of my required pediatrics courses, students were assigned to write a short paper on a vaccine preventable disease and the risks and benefits of immunization. Upon reading about this assignment in my syllabus, Dr. Daniel Flanders remarked:

What a missed opportunity to explore debates in science that are not yet settled: pros and cons of managing ADHD with psychostimulants, risks and benefits of circumcision, antibiotic use/overuse/emerging resistance, treating otitis media with antibiotics vs. watchful waiting.  What’s the sense of pushing each and every student to scrutinize the list of trivial and/or extraordinarily rare vaccine side effects? I note serious anti-vaccine innuendo all over this syllabus.

This extra time spent mulling over the settled science of vaccines meant that extremely common and important topics are omitted from the courses. Dr. Flanders notes that neither syllabi from Bastyr or SCNM cover cerebral palsy or Down syndrome, identifying surgical emergencies, identifying and managing learning disabilities, to name a few. Take a look at the topics covered in pediatrics 2 and the advanced course at Bastyr, to be sure:

Bastyr NM 7315 pediatrics 2 schedule
Bastyr University course schedule for NM 7315 Pediatrics 2 Spring 2010. Click to enlarge.

Bastyr University course schedule for NM 9316 Advanced Pediatrics Fall 2010. Click to enlarge.

I understand the difficulty with arguing for restrictions on naturopathic licensing based the material appearing in syllabi for naturopathic pediatrics courses. Certainly more than the scheduled topics of courses should be taken into account when deciding to grant naturopaths legal authority to practice medicine on children. However, given the information available in these syllabi and other documented problems with licensed naturopaths, I think the public should be more hesitant to accept the claim that NDs are competent primary care providers.

Dr. Mimi Poinsett, a pediatrician from Sonoma, CA, echoes this point nicely about Bastyr’s pediatrics offerings: “these courses alone are not adequate preparation for treating infants, children, and adolescents.”

Stop Naturopathic Pediatrics

Naturopathic programs do not provide their students with medical training that should instill public confidence. Yet, naturopaths argue that they deserve licensure based on the quality of their training and practice. Their argument is clearly flawed.

Here is a stark comparison. As a “naturopathic pediatrician,” I received less than 10% of the training that medical pediatricians receive in number of hours. Bonafide medical doctors don’t waste time learning homeopathy or other pseudoscience. They learn medicine.

Tracy Tannis, the naturopath who recommended an herbal tincture for a toddler with meningitis, clearly displayed a gross lack of medical competency. I would argue she complicated Ezekiel’s death. In general, a single case should not be used to make new rules. However, Tannis’s action is yet another example in a long string of events that highlights the danger of naturopathic medicine. Tannis went to the Canadian College of Naturopathic Medicine, one of the seven accredited naturopathic programs, where herbs are probably taught to be used against infections and where she had probably never seen a child as sick as Ezekiel.

When I searched for “meningitis” in my Evernote archive from my “pediatrics” coursework, I found quite a few examples of homeopathic and herbal treatments.

Naturopaths should not be considered doctors, and they should not be in charge of anyone’s health care, especially children.

Thank you to Drs. Daniel Flanders, Mimi Poinsett, Nathan Boonstra, Justin Smith, and Roy Benaroch for your insights.

Image credit: Rob Parker, some rights reserved.

30 Replies to “Naturopathic pediatrics is not safe

  1. Wow. Stunning. For all of those naturopaths out there who like to crow about how med school and naturopathic schools are the same…no. Just, no. I did 8 weeks of pediatrics clinical rotations in med school. That was 4 weeks on the regular wards, 1 week of NICU and 1 week of PICU, followed by 2 weeks of outpatient. Those were all at least 10 hour days, 6 days a week. This does not include the didactics we got during out first 2 years. Honestly, Britt, I’d say I saw more in ONE WEEK of a med school rotation than you saw during your entire “residency.” Unbelievable.

    The anti-vaccine bent of the curriculum is obvious. The only required paper was on vaccines? And listing the ingredients? Was the a school project or a Facebook posting? Embarrassing.

    One of the 6 course objectives is discussing recommendations regarding circumcision? Really? That warrants an entire objective, placed above vaccination in importance? And I really like how the objective of recognizing and managing common health concerns of children is thrown in there last at #6, almost like an afterthought.

    1. Dr. Flanders notes that neither syllabi from Bastyr or SCNM cover cerebral palsy or Down syndrome, identifying surgical emergencies, identifying and managing learning disabilities, to name a few.

      This was the jaw-dropper for me.

      Nothing on Down Syndrome? Nothing on managing learning disabilities?

      Man, I think of pediatricians as front line resources for those issues with children.

      Apparently Naturopathic Pediatrics means “throw an herbal supplement at it.” If it is an issue that needs actual intervention, don’t bother.

      You can see it’s all a sham. Throw herbs at something that will likely take care of itself. However, if there is a REAL problem that snake oil won’t cure? Can’t do it.

      It’s like the miracles at Lourdes. You see all the eyeglasses thrown away. But where are the artificial limbs? Oh, God doesn’t cure the hard stuff. Apparently, God is a Naturopath.

      1. Silly, the alt-med solution to Down Syndrome and learning disabilities is to make sure you’re Doing All The Right Things and Eating All The Right Foods when you’re pregnant so they don’t ever happen, ever. If your child is less than “perfect,” it’s probably your fault. I mean, learning disabilities? Did you vaccinate? Fail to breast-feed the kid until they started school, while maintaining a 100% organic, gluten-free diet supplemented with cod liver oil so you can make the perfect milk? You must have done something.

        But, for real, I wonder if learning disabilities are bundled into “gastrointestinal.” It seems to be a thing in alt-med circles to attribute all kinds of things, including learning disabilities, to bad “gut health.” “Gut healing” seems to be a major industry and parents get told that the proper regimen–and some of these sound completely crazy-making and expensive–will cure their child of everything from allergies (real or made up) to ADHD to autism. I’m sure Britt could shine a brighter light on this than I can though.

        1. Good point on the gut thing. Did you see the recent Orac post on the “functional medicine” comparing the treatment for a cancer patient? The Naturopath prescribed treatment:

          Melatonin: 20 mg QHS
          Digestive enzymes AC
          Probiotics: 60 billion CFU BID
          Lactobacillus acidophilus NCFM
          Bifidobacterium animalis Bi-07
          Medical food shake bid
          Vitamin D3: 5000 IU QD
          EPA:DHA: 6000 mg QD
          Wheat germ extract: 5.5 g QD
          Oral vitamin C: 18-24 g QD
          Standardized herbal inflammation relief supplement

          Notice the generic “Digestive enzymes” and “Probiotics” but also Lactobacillus acidophilus and Bifidobacterium animalis, two addiitonal “biotics”

          1. The gullibility of naturopaths is astounding. Manufacturers of dietary supplements that naturopaths foist upon their unwitting patients eagerly use that to their commercial advantage; a practice exemplified by so-called “professional” lines sold at higher prices than consumer lines. So-called “probiotics”, which are nothing more than bacteria, are popular among naturopaths because of the millions of dollars and euros spent in their promotion by manufacturers, rather than sufficient evidence to demonstrate their benefits against disease in well controlled clinical trials. As a result, industry awards are given to manufacturers for sales of products, including probiotic products in the U.S., even when they are not subjected to clinical trials to adequately demonstrate efficacy for their intended use. In other cases, an herbal dietary supplement can show half the contents of active constituents found by HPLC in other products of the same species and still receive an industry award. In at least one case, using a questionable and generally unaccepted means of analysis, the manufacturer claimed their product contained the highest level of active constituents of any such product on the market. Handing out awards for sales instead of quality and demonstrated efficacy is a disservice to consumers that serves to further tarnish the dietary supplement industry along with their ardent promoters.

  2. While I would shorten the opening sentence to, “Naturopathic practitioners should be banned.” Period, the death of Ezekiel Stephan is entirely on his family, and Tracey Tannis has been set up by the defense as one of several people on whom they can shuffle off blame in an attempt to reduce the parents sentence, or perhaps get an acquittal or hung jury. And by “family” I do not mean just the parents, David and Collet. The 500 pound elephant getting little or no coverage in this story is David Stephan’s father, Tony Stephan, and his highly lucrative and venal supplement ‘cure’ scam company, Truehope — which is where David Stephan works in sales and marketing, and Collet was also employed before quitting to become a full-time housewife.
    ” is
    Only certain things come out at trial, and only some of those are reported by the press. Press accounts make mistakes in recounting narrative, as do official reports. Tannis testified she had never met Collet Stephan before Collet dropped by to pick up the BLAST, at which point Lexie Vataman (the natuopathic remedy dispenser / receptionist who testified at the trial) apparently introduced the two. Tannis testified that at that brief meeting she had no idea Collet was the mother who had clted Vataman to inquire about “something to boost the immune system”. Tannis also testified that she never recommended BLAST for the caller. There has been no evidence that the Stephans had ever visited Lethbridge Naturopahic for any purpose before Collet picked up the BLAST. (I’m not saying I know they had not, only that it’s not in evidence.) The physicians report by Dr. Jenn D’Mello says:

    They called their naturopath in Lethbridge to ask for recommendations for treating viral meningitis and were advised to start him on something called BLAST.

    Which suggests that the Stephans were regular patients of Tannis, that they spoke to Tannis, and specifically asked for a treatment for meningitis. All of which are unsupported by testimony. D’Mello was recounting what Collet told her on the night Ezekiel was brought to the hospital, and either she just made false assumptions from vague and possibly confused things Collet told her, or Collet was not being completely truthful.

    AFAIK, it’s also not clear whether what Collet got from the clinic was in fact Natural Formulae BLAST, though that is my assumption. This is an OTC product also sold in health food stores, so Collet did not need anyone’s permission to get it, nor necessarily to go to Lethbridge Naturopathic for it.

    The whole business with the BLAST stinks, in that asking for advice from either Vataman or Tannis would be completely inconsistent with Collet and David Stephan’s history. They are completely DIY healthcare folks, do not trust ANY sort of medical professionals, and apparently never had Ezekiel seen by any doctor, legit or quack. That Collet called Lethbridge Naturopathic, and asked Lexie Vataman for an immune booster is bizarre because Truehope markets exactly such a product, the Stephans told D’Mello they had been using it during Ezekiels illness, and that they’d treated him with it for colds in the past. This is not obvious in the physician’s report, where D’Mello wrote:

    They also started Ezekiel on some herbal/naturopathic remedies which they believe help fight off viral infections and have given Ezekiel in the past when he has a cold. These included olive leaf extract, garlic, and methylsulfonylmethane (MSM).

    Again, I can’t say whether D’Mello didn’t understand Collet, or Collet was being evasive, but “olive leaf extract” is almost certainly not a generic thing here, but rather Truehope OLE:

    Antioxidents For A Healthy Immune System… naturally strengthen your immune system… a natural extract from the olive leaf, standardized to 17% Oleuropein. The antibacterial, antifungal effects of Oleuropein are well-known and are even thought to help reduce the need for pharmaceutical antibiotics. Boost immune system and bowel function… using Truehope OLE.

    We got OLE, so we don’t need no stinkin’ antibiotics. Not that OLE is Truehope’s main business. That would be selling a fairly generic vitamin formula as a cure for serious psychological disorders, including bi-polar and schizophrenia, at outrageous prices, leading to several deaths, attempted Canadian government intervention and several lawsuits, all fended off by Truehope attorney Shawn Buckley, who, of course, is the defense counsel for David and Collet at this trial.

    In any event, among the points where press accounts seem to be incorrect is in indicating that when Ezekiel took a turn for the worse on the morning of the day he was rushed to the ER, his parents were concerned enough to drive him into Lethbridge to get the BLAST. This has led to much of the speculation that they had taken Ezekiel for a consult with Tannis, and that she ‘prescribed’ BLAST without examining him. However, here is what D’Mello wrote in the physician’s report.

    The following day the family decided to drive to Lethbridge to do some errands which included picking up the BLAST… Ezekiel seemed a bit more alert that morning but he was too stiff to be successfully placed in his car seat so his crib mattress was put in the back of the car and he laid on that for the drive.

    Thus the impression D’Mello appears to have received from Collet is that getting the BLAST wasn’t all that urgent, and that they brought an improving Ezekiel along on their errands as they couldn’t leave him home unattended. Given his condition that evening – “he was delivered to EMS ‘not moving or breathing, with his eyes closed and face ashen in color. An electrocardiogram… showed a flat line’…” – well, draw your own conclusions.

    If it were up to me, I’d shut-down naturopathy entirely on the basis of what Britt covers in the body of the OP, and in many others posts here and on SBM. However, in the Ezekiel Stephan case, the defense is using the antipathy towards naturopaths to deflect blame: first of all, from Tony Stephan and Truehope, and second from Collet and David Stephan. Tracey Tannis appears to be an innocent bystander here, guilty of no more than selling an OTC product approved by Health Canada that just be tossed into a cart at a health food store. The ‘hang the naturopath’ coverage, combined with the absence of inquiry into Tony Stephan’s role — you’d think he might have taken an interest in his grandson’s illness, yes? – is helping Buckley tremendously in his efforts to discredit Tannis. For she is the only witness who has stated definitively that Collet was told to take Ezekiel to the hospital: “take the child to emergency right away.”

    1. As I wrote:

      Tannis’s recommendations were dangerously contradictory. On the one hand, Tannis claims to have urged Ezekiel’s mom to seek emergency care, but at the same time, she said, “This herbal product BLAST can help.” In selling a concoction to treat meningitis, Tannis diluted whatever medical urgency she claimed to convey.

      The Stephans have a serious problem on their hands in addition to the grief of Ezekiel’s loss. There is no denying that Tannis played a role, but it seems that Ezekiel didn’t have much of a chance even if she wasn’t involved. I think it is important to put this interaction into the context of how naturopaths convince others that they are “doctors.” This is another glimpse into the issues that states/provinces will encounter with naturopathic licensure and self-regulation.

      1. Doctor Tracey Tannis testified that her receptionist, Lexie Vataman, received a call from a woman in March of 2012, saying a midwife and registered nurse had seen her child, and they believed he had viral meningitis and were looking for a treatment. Tannis says Vataman pulled her out of an appointment with another patient to ask for advice, and that she immediately responded by saying, “You need to tell the lady to take the child to emergency right away.” She says she waited to hear Vataman relay the message, and then went back to her patient. Tannis explained that meningitis is not something she is prepared to handle at her clinic, and that emergency care is required. Questions then turned to a later point, when Collet Stephan came to the clinic to purchase an echinacea mixture called Blast to treat the child. Tannis stated that while she had a brief conversation with Collet, she didn’t realize it was the same person who had called about a treatment for meningitis, adding, “I really thought that woman went to emergency.” Questions continued about whether it was Tannis who had recommended the echinacea mixture, but she flatly denied it.– Lethbridge News Now 3/16/16

        You refer to Tannis testimony as ‘claims’, which is fine, but then without qualification, use a direct quote to attribute to her something she has explicitly denied. That’s unethical, and perhaps even defamatory. This kind of thing undermines your credibility.

        The push back against naturopathy is important public health work, there’s more than enough broad-based evidence (as detailed in the body of the OP) to raise alarms. The extremely dubious representation of Tannis as culpable in Ezekiel’s death needlessly risks back-firing and discrediting your project.

        Especially when you place Ezekiels death in the context of the Stephan family history, Tannis likely played no direct role whatsoever. Absolutely nothing in this case relates to naturopaths convincing others that they are “doctors.”. David Stephan was raised within an ideology that doctors are superfluous. The convincing was done by his father, who has no medical training or knowledge whatsoever.

        Given what little we can actually establish of the facts in this case based on the testimony, the worst we can say of Tannis is that she operated a business at which a naive mother with a sick child who had been warned that viral meningitis was an outside possibility and called to request “something to boost the immune system” MIGHT have been told by the receptionist that “BLAST can help.” That in itself poses issues for states/provinces and federal governments in term of regulation, going far beyond the licensure of naturopathy. The central one is that products like BLAST and Truehope OLE available for sale OTC are permitted to make claims unsupported by valid science, or perhaps even disproven by valid science.

        What is absolutely true is that Ezekiel’s life was sacrificed to reliance on ‘natural cures’ in the face of a serious disease. Regardless of how this played out in terms of which individuals did what and for what reasons — these would all in some ways be reflections of a broader ideology. Thus, his death points to the social problem presented by the ideology one way or another.

        A proper, defensible, logical argument would be:
        A) Belief in natural curses, specifically the exclusive use of herbal preparations in the face of infectious disease, lead to the death of Ezekiel Stephan.
        B) Natuopaths are taught to treat infectious disease with herbal preparations, encouraged to do so by their peers in chat forums, and in fact do so on a regular basis. In addition, they do NOT have the diagnostic training and experience to distinguish serious life-threatening infections from relatively minor self-limiting conditions.
        C) Therefore, tolerance, let alone licensure, of naturopathy is likely to lead to more preventable deaths like that of Ezekiel Stephan.

        Let us imagine an alternative scenario that could have (but didn’t) taken place here. What if:
        1) The parents weren’t in the Natural Cure business themselves, just generally dedicated to ‘the natural way’
        2) Had thought their child had a nasty case of croup, asked their midwife-friend to take a quick look-see, and she HAD NOT mentioned meningitis – saying just, ‘yeah, I think it’s croup, but it could be something else, so to be safe you should have him looked at by a doctor’.
        3) The following day, the child had presented as the Stephan’s claim Ezekiel did — lethargy, loss of appetite and less frequent BMs, some stiffness, mild fever,; no cough, congestion, vomiting or diarrhea, and no one else in the family feeling sick.

        This scenario then likely could either have:
        A) Sent Mom off to the Web all by herself to find a super-duper immune booster, locating BLAST and/or OLE, buying the claims for them, picking them up at the health food shop, and using them to treat the boy until it was too late.
        B) Led Mom to call a naturopathic clinic seeking a recommendation for an immune booster for an infant who appears to have persistent croup but maybe something else? The call could have been taken by a completely untrained receptionist who could have said “the best immune system booster we carry is BLAST”, so Mom just picks up a bottle of that, and no opportunity for intervention arises.
        C) Moved Mom to take the tot to the naturopath, who listened to her description of the lads symptoms, found his condition consistent with that account upon a fairly cursory examination, and just said ‘pick up some BLAST at the counter on your way out, and call me back if things get worse…’

        (IANAMD, but from what MDs have said about bacterial meningitis and pleural emyema, the odds that Ezekiel Stepahn was actually in the condition Collet described strike me as. uhh, slim.)

        Thus, while Tannis probably had no involvement in the death of Ezekiel Stephan, that says absolutely nothing positive about naturopathy or DIY natural cures. There’s no causal connoection, but these thing are all under the same ideological canopy, which Tannis’s practice is one of the many, many stems of support, maintenance and expansion. It’s not about what any one quack does, but about the climate created by the proliferation of the quack propaganda army. Being part of that is bad enough, yes?

  3. The core sentence in this article is imho: ” Most of my colleagues went directly into private practice [after graduation], and some were hired as clinical instructors.” In Austria, as in many European countries a freshly graduated MD could do anything except going into private practice.In order to do so, s/he would need a residency of at least 3.5 years in a hospital (this is for general practicioners), if one wants to specialize (f.i. in pediatrics) it’s 6 years residency. I.o.W. as a specialist you need 12 years training, as a general practicioner it is 9.5 years. Compare that to a Naturopath.

  4. The core sentence in this article is imho: ” Most of my colleagues went directly into private practice [after graduation], and some were hired as clinical instructors.” In Austria, as in many European countries a freshly graduated MD could do anything except going into private practice.In order to do so, s/he would need a residency of at least 3.5 years in a hospital (this is for general practicioners), if one wants to specialize (f.i. in pediatrics) it’s 6 years residency. I.o.W. as a specialist you need 12 years training, as a general practicioner it is 9.5 years. Compare that to a Naturopath.

  5. Isn’t it damnably significant that that naturopath didn’t even trouble herself to look at the child? That wouldn’t have changed the situation, but just the same. Talk about the unimaginable lightness of being. I wonder if that’s in the court record.

  6. Going over the substances listed under “Naturopathic First Aid Kit”, few of the items have ever been the subject of a randomized controlled clinical trial in a pediatric population to show either safety or efficacy. How is that being professional? And “Bach Rescue Remedy”? One might just as well give a child or infant a shot of brandy.

    1. The shot of brandy would at least have some therapeutic effect! Unlike the contents of my spice rack, which is basically what that “first aid kit” is.

    2. I wouldn’t discard the first aid kit entirely. What if you had a long workday and can’t find a soothing peppermint tea ? Or it is hellish cold outside and you have to warm up using a feuerzangenbowle ( – without cinnamon you have to freeze and will possible get a cold. These are real emergencies. If you happen to travel through Romania, specifically through the Carpatian Mountains this kid could save your life – especially if you don’t carry a cross or a stake with you.

    3. I wouldn’t discard the first aid kit entirely. What if you had a long workday and can’t find a soothing peppermint tea ? Or it is hellish cold outside and you have to warm up using a feuerzangenbowle ( – without cinnamon you have to freeze and will possible get a cold. These are real emergencies. If you happen to travel through Romania, specifically through the Carpatian Mountains this kid could save your life – especially if you don’t carry a cross or a stake with you.

  7. Our EVIL ND treated my partners daughter’s chronic painful ear infection with a herbal infused oil successfully in a week, after 4 courses of antibiotics from the MD did absolutely nothing but destroy the child’s gut microbiome and give her chronic yeast infections. The EVIL ND identified the cause of the ear infection as fungal, not bacterial (despite the doc giving 3 extra courses of antibiotics, after the first course did not help).

    Maybe it was because the doctor spent (literally, i timed it) 5 and a half minutes with the child, and forgot to ask the parent any questions about the condition of the child or if the antibiotics made a difference. The only thing i can thank the MD for is the fact the poor kid now has chronic UTI’s and issues with yeast.

    Interestingly it seems to be the people who have never seen an ND in practice or who possibly feel threatened in one way or another, that are the most outspoken against the profession. If ND’s were as evil as your posts propose, wouldn’t it be those of us who pay out of pocket to see an ND, who would be the angriest and most outspoken?

    1. Nothing in Britt’s post says that ND’s are evil. It says they are under-educated which is just demonstrably true. I doubt Britt considers her former self to be “evil.” Just not qualified to provide pediatric care.

      I don’t know the details of your experience with that MD but certainly there are bad MDs out there–although perhaps the antibiotics did work? Or the infection resolved on its own. I’m not a pediatrician and, unlike an ND, I’m not even pretending to be one but I know enough basic science to know that oil does not cure an ear infection of any kind. It’s my understanding that warm oil can be used to soothe the pain of an ear infection (at any rate it used to be used that way and I don’t know if it still is) but that is symptom treatment. It’s not going to knock out whatever is causing it.

    2. Skinny, this is about probability. One can get the working treatment even by say an car-mechanic with some medical knowledge, however the probability that car-mechanics in general will be able to administer the correct treatment reliably is far lower compared to MDs. Why ? b/c an MD is trained and a car-mechanic is not. The same time the probability that MDs make mistakes is far lower than with a car mechanic. NDs are not properly trained, and that’s it.

    3. How did the ENT diagnose a fungal ear infection? Was there a culture performed? What was the fungus?

      Or…was it just a made up diagnosis, just like the made of diagnoses she has given your child of chronic yeast infections and a destroyed gut microbiome?

    4. A fungal ear infection? How would the ND know that? How did he/she test for it? As for chronic UTIs and issues with yeast – really? Or is that a line the ND has given you so you keep coming back? If MY child had chronic UTIs I’d be in a urologist’s office in a heartbeat, not a ND.

      1. Absolutely correct b/c recurring infections with yeast may point to some underlying problems that should be excluded.

      2. Absolutely correct b/c recurring infections with yeast may point to some underlying problems that should be excluded.

    5. Time for ear infection to resolve with no treatment: 1 week. Cost $0.
      Time for ear infection to resolve with pain relief: 1 week. Cost $170 ($20 for “herb infused oil” plus office visit).
      Most ear infections go away on their own. Given that antibiotics are generally effective in 48-72 hours, ‘4 courses of antibiotics’ is too much. Did you demand that treatment and or doctor-shop?

  8. As a mother of a toddler who is breastfed and in cloth diapers, I regurlarly come across unsubstantiated woo from other granola mothers (in real-life and in forums). My children are fully vaccinated and they have regular visits to a real pediatrician. That being said, pediatricians need to ask themselves why parents distrust them (and why they turn to NDs). I am a volunteer breastfeeding support counselor and I can’t count the number of times I have heard of a pediatrician giving terrible breastfeeding advice. You say that pediatricians have more hours of in-class and clinical training. But what is the value of 10,000 hours of telling mothers their milk supply must be low because the baby wants to nurse more than every 3 hours? (for example) Parents just want to see a bit of humility in pediatricians and better knowledge of breastfeeding basics. Keep up the great work with your blog!

  9. According to the certificate, you completed a “postdoctoral” residency program. Given the books listed in the syllabus, I can’t help but wonder what constituted a doctoral thesis.

  10. As an Albertan and concerned citizen, I wholeheartedly agree with agree with the need to ban naturopathic pediatrics from children. I know that this will come as a shock to many people who will hear me take such a strong position, but I think this case with Ezekiel underscores the importance of such a position. I think most people think that CAM medicine is some benign practice of herbs and natural medicines designed to help people. I know that people have a good strong skepticism and concern when it comes to relationship between pharmaceutical companies and many physicians-which I share as well. But the problem is that there thinking becomes very confused when it comes to the actual pseudoscience that is apparent in CAM. I don’t think people really understand, until now, the real dangers posed by these approaches to medicine. Perhaps this tragic case will help to turn the cultural tide to a more skeptical eye towards these approaches while not being blind to the problems in our medical systems.

  11. Sorry I’m late to the discussion, but thank you for pointing out the “naturopathic pediatricians” are not pediatricians at all. I state this as a pediatrician in Arizona who has had to read the nonsense posted by the above-referenced Matthew Baral, who fancies himself a naturopathic pediatrician and is basically the one-person “dept of pediatrics” at the naturopathy school here in Phoenix. Baral is clearly anti-vaccine, but that is to be expected given that the “classical” textbook for naturopathy school is “The Textbook of Natural Medicine” which has anti-vaccine sections within.

  12. One of the most difficult things to do in life in realize that you’ve driven a long way down a wrong road, stop, and make your back. It sounds so trivially easy, but few will do it with success.

    Britt is a brave young lady.

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