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If there’s one area of “alternative” medicine that saddens (and angers) me, it’s the antivaccine movement. Most alternative medicine only risks harm to the user. But antivaccinationists threaten public health. Their actions can harm the most vulnerable in our society – often children, and others who depend on the herd immunity that vaccination provides. After my last few naturopathy vs. science posts I thought I’d take a bit of a break with another subject. However, last week ex-naturopath (and friend of the blog) Britt Hermes flagged a post from a naturopath that stunned me. Here was antivaccinationism and naturopathy, all rolled into a blog post about three children with a parent that doesn’t vaccinate. Heather Dexter, who claims to be a “Board Certified Naturopathic Doctor” in Michigan, blogs at likemindedmamas.com. She recently used her blog to describe, in astonishing, horrific, gut-wrenching detail, how she let three of her children suffer with whooping cough without seeking proper medical attention. The post was pulled down after a few days, but has recently reappeared with some modifications. (The original post, which I am quoting from below, has been archived and can be found here or here). I strongly encourage you to read the entire post in its entirety. Because amazingly, not only did Heather Dexter let her three children suffer through weeks of pain with whooping cough, she also subjected them repeatedly to invasive (and useless) alternative medicine. Yet she claims to have no regrets.

Whooping cough is preventable. Antivaccinationists oppose this.

Vaccination has likely prevented more deaths in the past 50 years than any other health intervention. Infectious diseases that used to kill millions have been fully or almost completely eradicated – all through the effectiveness of vaccines. 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. There is an effective vaccine is for pertussis – whooping cough. Pertussis is caused by the bacteria Bordetella pertussis, and infections can be serious – particularly in infants. It causes rapid, violent coughing and then a sudden inspiration of breath – the “whoop” sound. If you’ve never seen it before, go watch some videos of it so you know what it looks and sounds like. It’s upsetting to watch, and can terrify parents. Pertussis can kill infants. In older children, it can cause coughing spell so violent children can pass out – or fracture ribs. They often end up with bruised eyes and broken capillaries – like the picture above – simply due to the intensity of the coughs. Having watched the videos, I find it difficult to accept that a parent wouldn’t choose to prevent this disease in their child. Because you can, easily. The DTaP vaccine protects against pertussis. The introduction of a vaccine reduced the incidence of pertussis infections by 99%. It is highly effective (98% after the 5 doses) and the pertussis vaccine has no serious side effects. None. The statistics demonstrate the effectiveness of the pertussis vaccine – this disease has almost been eliminated, and so have the harms (like residual lung damage), the misery, and the deaths. Just this week there emerged new evidence that suggests a relationship between pertussis and epilepsy; children who have had hospital-diagnosed pertussis were almost twice as likely to subsequently be diagnosed with epilepsy. While this does not establish cause and effect, it suggests that there may be more damage caused by a pertussis infection that initially thought. All the more reason to be vaccinated, and further evidence against the idea that “natural” immunity is somehow superior to the immunity conferred by vaccines.

Naturopaths and advocates of “natural medicine” have long opposed vaccination, dismissing it as “unnatural” for as long as vaccines have been around. Benedict Lust, who introduced naturopathy in the United States, stated his opposition to the smallpox vaccine in 1918, in his Universal Directory of Naturopathy . Lust introduced the core tenets of the naturopathic belief system: natural is better; vaccines are unnatural (and therefore bad); we’re being poisoned from within (i.e., you need to detox); and naturopaths treat “root causes” while medical doctors don’t. None of these concepts have any basis in reality. The eradication of smallpox, due to the vaccine, had no effect on naturopath practices. That’s because naturopathy is a belief system, rather than a science-based practice. Naturopathy is based on the idea of vitalism, a pre-scientific belief that some type of magical “energy” is a part of all living things. The idea of vitalism was disproved by Wöhler in 1828, yet the idea remains central to naturopathic ideas about medicine. Naturopaths believe their treatments restore this “vital force”. The practice of naturopathy has evolved over time into a mix of disproven or unproven health practices that includes homeopathy, acupuncture, “detoxification” and herbalism, along with the occasional science-based belief repackaged as “alternative”. To be clear, not all naturopaths are antivaccine today – but the evidence demonstrates that antivaccination sentiment persists. 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. And a survey of Massachusetts naturopaths and homeopaths noted that most did not recommend vaccination. Additionally, a survey of children’s records from an Ontario naturopathic clinic identified 8.9% of children had not been vaccinated. And a year ago, I blogged about the president of the College of Naturopathic Doctors of Alberta, Allissa Gaul, who refused to endorse vaccination – even as that province was facing an outbreak of whooping cough and measles. While naturopaths claim to be primary care providers, their continued hostility to vaccination, and their persistent use of unproven and disproven therapies has raised questions about their ability to provide care based on an accepted medical standard.

The consequences of seeking “natural” immunity

Past posts on naturopathy have detailed the unscientific advice that naturopaths provide on different subjects. This is a unique situation where Dexter, a naturopath, is treating her own three children: 6.5 years, 3.5 years, and 9 months. (I will redact their names from this post). The first to catch whooping cough was her eldest daughter:

My six year old, XXXXXXX developed a cough. No big deal. Nothing that I would ever find concerning. Nothing that a few natural health remedies and some cuddling couldn’t wipe out in a few days. I mean shoot, we had been doing things naturally for almost six years with nothing but success each and every time. 14 DAYS XXXXXXX’s cough had progressively gotten worse. I decided I was not doing enough. The regimen I had her on was not nearly what it could have been. So I intensified it. Homeopathics; Aconite followed by Spongia and herbal tinctures Autumn Olive Berry, Black Walnut, Vitamin C, Minerals Zinc and Magnesium, and several herbal blends, along with loads of eucalyptus oil given or applied several times daily

With the onset of a highly infectious disease, Dexter started with homeopathy (sugar pills), vitamins, oils, and herbal remedies – none of which have any demonstrable value for the treatment of pertussis. (In an update to the post, Dexter has added “chiropractic care, probiotics, and optimum nutrition” to the list above. Chiropractic and probiotics also have no value for pertussis infections.) No action was taken to ensure her other children were vaccinated, or that her eldest daughter was isolated from from her other children or the community. And as might be expected with a highly infectious disease, her son contracted pertussis next:

YYYYYY, my 3 year old son, began coughing. Yes…it happened to be the same exact cough XXXXXXX had started with nearly three weeks ago. At this point, XXXXXX’s cough was beginning to scare me. She would wake in the middle of the night, multiple times a night, coughing so hard that she would puke over the side of her loft bed, followed by turning purple and then finally gasping for air. It was at this point that I realized this was no ORDINARY cold. I was in need of a second opinion… some non-parental help. I scheduled an appointment with one of my best friends and colleagues, Sarah Mokma of Rooted Well, who is also a Naturopathic Doctor. I left the appointment feeling confident that once again I had this all under control. I jumped on Amazon, placed an order, and headed to our local health food store to get the natural remedies I didn’t have on hand. I added many things to XXXXXX and YYYYYY’s programs including: Olive Leaf Extract, Elderberry Syrup, Pau D’arco Extract, Light Therapy and Reflexology. We also stuffed large blankets under the head of their beds, so that they were sleeping on a 45 degree incline. This allows the lungs to clear and breath to come easier.

(Emphasis added.)

So at 21 days, with two children now infected, and one turning purple and gasping, the only intervention was more supplements, and two additional ineffective treatments: light therapy and reflexology. Still no medical referral or assessment.

After over a month, the children were still clearly suffering:

YYYYY’s cough followed the exact same pattern as his older sister. After any small amount of running, playing, or gymnastics movement (which he had weekly) YYYYYY would break into intense coughing until he either puked or hacked up a glob of mucus. I was actually shocked each week that we didn’t get kicked out or sent home in the middle of his gymnastics coughing, yakking and hacking fits. {NOTE: He was no longer contagious at this time and the running caused him to expel mucus from his lungs. THIS WAS GOOD FOR HIM! Fresh air and exercise are the best things for sick kiddos.} During the night, YYYYYY would cough until he barfed up mucus, proceeded by crying and screaming fits. He was genuinely terrified each and every time he woke from sleep without breath. At this point in time my husband, and I were now waking every 30-90 minutes through the night to clean up after or console one of two coughing, puking, screaming children. This on top of a co-sleeping, nursling who expected me to be near her at all times. She often woke up to the sounds of her siblings coughing, puking, screaming, and crying that was happening every night…continuously. And we knew it was just a matter of time before ZZZZZ developed this same “thing.” One thing was certain, the situation was going to get worse.

(Emphasis added.)

Despite being infected with pertussis, Dexter allowed her son to participate in gymnastics class. Taking antibiotics, carriers are infectious for a few days. Without antibiotics, carriers can spread the infection for weeks. So it’s possible her son was still infectious, possibly putting the community as risk. And despite what sounds like apnea, Dexter still did not seek medical care, nor was she willing to face the objective facts:

XXXXXXX had been coughing for 60+ days. We hadn’t slept longer than 2 hours in months. UGGGGGH. Sleep, it’s for the select few parents who probably drug their kids or lock them in their rooms. How I just wanted to sleep for six hours straight for just one night, it would have been miraculous. The term “walking dead” described the new me. It was during this time, the first week in December that my husband, Scott, sat me down, looked me in the eyes and said, “I trust you, but I am scared that one of our kids is going to die. You know it is just a matter of time before ZZZZZ develops whatever it is that XXXXXXX and YYYYYY have. She’s only 9 months old. It’s going to be bad, Heather. I think we need to go to the hospital. What are you thinking?“ Part of me felt blind-sided and hurt, unsupported and ready to blow…that was the exhausted me. I took a deep breath and looked away, thinking before I spoke. I knew he had always been and still is the logical one. I react emotionally, instinctively, often times before my mind has fully connected with my words. My truth just seems to spill easily from my mouth, a lot of times without the sweetness of being sugar-coated…just bluntness, pure honesty. However, I have learned that my truth does not belong to all of humanity. Each person is entitled to their beliefs and logic or training. Logical me responded with, “I still feel confident that we are about to turn a corner here anytime now. I would like to schedule an appointment with my Naturopathic Doctor in Mt. Pleasant and see what I’m missing. This has got to be an illness that needs to be remedied in layers because it is quick to mutate. I am certainly not interested in an antibiotic, x-rays, a series of steroidal breathing treatments, or a vaccine which is all the hospital is going to recommend for us. I do believe their immune systems were built to handle this. I just need to find out what I am working with. XXXXXXX, is obviously getting better, you certainly cannot deny it. I know the other two can and will work through this, it is just a super slow process due to the lack of experience, or on the job training, done by their immune systems They just haven’t been a whole lotta sick in their lives, babe! This is their time to gain immune stimulation.”

(Emphasis added.)

Dexter illustrates her steadfast adherence to the naturopathic belief system, even when facing pleas from her husband. Practices and observations that were not congruent with the naturopathic philosophy continued to be discarded, and rationalizations were offered. She should have recognized that medical care was necessary. Instead she sought confirmation bias in the form of the advice of another naturopath:

Dr. Amy spent about 30 minutes with each child and created a rigorous and intensified program of additional items to add to our programs. We continued many of the things I was doing and added many essential oils: Ravensara, Frankincense, German Chamomile, Herbal Lobelia, Several Probiotics, and Enemas…yup, I squirted things in their rear end. Turns out the best way to clear out the lungs is through the rectum…enemas. Her additions meant that I was literally doling out supplements, applying essential oils, or giving enemas to one of my kids every three to four hours around the clock. I cancelled everything on my calendar for almost four weeks (the week prior to Christmas, Christmas week, New Year’s Week, and the first week in January) focusing only on the well-being of the kids.

(Emphasis added.)

Here we have another aspect of naturopathy with deep roots in practice that continues to appear in treatments today: the idea of autointoxication, treated by enemas that “detoxify” the body. There is no medical justification for enemas in children with pertussis, nor was there any need for the ever-expanding array of herbs and supplements. None of the treatments the second naturopath recommended had any medical value. And there was still no referral to a medical doctor.

The post then describes how Dexter’s own father, a veterinarian, encouraged her to seek medical proper medical care – advice she refused. (This section was subsequently removed):

During this time, however, I received a very stern “talking to” from my father. He’s a veterinarian and has been for just shy of 40 years. While holding ZZZZZ, he said to me, “Heather, there is a time and place for every thing and the time to go get an antibiotic is now. It may be that your pride has got you confused. I have watched you over the years heal ailments that I never imagined possible with natural remedies. I still wouldn’t believe the stories, if I had not witnessed you going through the process. However, I have also witnessed medicine save many lives over the years. I would hate to see you make a poor choice with your children at the expense.” HOLY SHIT… What? Did he honestly believe I was sitting there doing nothing? Couldn’t he see I was taking all the care in the world trying to make this work and heal them naturally? My heart broke. Tears streamed down my face. I grabbed my baby, turned my back to him and walked away. Did I know what I was doing? Had I gone too far? I headed to the bedroom to nurse her and myself to sleep. I called my mentor and the founder of my Naturopathy school to gain yet another naturopathic perspective. She had nothing but good things to say. She once again boosted my morale. It was all I needed to hold strong over the holiday season.

More confirmation bias from fellow naturopaths, and continued rejection of anything outside the naturopathic belief system.

The suffering continued:

By mid-January, XXXXXXX was doing great. YYYYYY was turning the corner, for the better. He was now only coughing moderately throughout the day and waking only a couple times a night. But ZZZZZ’s breathing had now reached the scary point. She was now coughing until she puked, often times turning purple in the process. This was followed by crying, which would cause the process to repeat itself until often times she would just fall asleep due to pure exhaustion.

(Emphasis added.)

Fortunately, eventually, her children appear to have fully recovered. Yet despite all of this avoidable misery, Dexter still shows no sign of insight or introspection:

We made it through using only natural remedies. Seeking no medical attention. We did it. My children developed REAL and TRUE immunity from being exposed to this bacteria [sic] and fighting it off naturally. It has been my biggest challenge to date as a mother. This mother conquered. I encourage you to take the time to listen to this immunologist and hear her speak on the importance of Active immunity vs. Passive immunity.

Dexter sees all this as her accomplishment rather than a horror story. Her priority seemed to be proving that her naturopathic view of reality was the right one – even when it meant risking the health of her own children. Yet ultimately, she accomplished nothing. Naturally acquired-immunity isn’t superior, or even lifelong – for pertussis, immunity is short lived and will wane within years. It is no more “true” than the immunity provided by vaccination. Yes, the vaccine’s effectiveness will also wane, but you don’t need to endure the infection, and the risk of permanent harm and death, to get the benefit. You simply need to be immunized.

Dexter concludes her post by continuing to offer apologetics for the naturopathic worldview. She describes “pharmaceutical creations” as “experimentation on your family”, and then goes on to recommend a long list of supplements (and enemas) to treat pertussis, while listing what she sees as harms from medicines like antibiotics and vaccines. Would she do anything differently? It doesn’t appear so:

Honestly, had I known from day one that it was Pertussis, I would have simply started hammering the remedies that I know work best to eliminate bacteria and stimulate the immune system. I would have made an appointment immediately with my Naturopathic Doctor and introduced all of her suggested remedies as well. I am very happy that I held strong, trusted and had faith in Naturopathy. I am thrilled that antibiotics were never “needed” and that all three kiddos were able to build true immunity to Pertussis.

The naturopathic standard of practice is homeopathic

At this point it should be obvious that there was never any recognition by any of the naturopaths involved (either Dexter or her colleagues) that they didn’t know what they were doing. Dexter even admits that her husband diagnosed pertussis before she did – she was unwilling to accept the objective reality of the situation. The naturopaths were playing doctor without any actual medical knowledge or any clear treatment plan. As is common in naturopathy, they made it up as they went along. If supplements don’t help, try essential oils, or probiotics. Or chiropractic. Or reflexology. All of the treatments they used share one characteristic – they are all ineffective for treating pertussis. Not understanding the limits of naturopathy and the benefits of actual medicine, Dexter (and the other naturopaths involved) failed to rationally assess the situation, and to appropriately refer to medical professionals. Failing to do so, they put these children at risk, and risked the herd immunity in the community. But objective facts don’t seem to matter. Dexter’s “facts” are based on her philosophy – nowhere was this made more clear in a statement that is frankly stunning, coming from someone that claims to be a doctor:

I react emotionally, instinctively, often times before my mind has fully connected with my words. My truth just seems to spill easily from my mouth, a lot of times without the sweetness of being sugar-coated… just bluntness, pure honesty. However, I have learned that my truth does not belong to all of humanity. Each person is entitled to their beliefs and logic or training.

If the fact your child is gasping, vomiting and turning purple from oxygen deprivation doesn’t signal that something is seriously wrong, then I honesty don’t know what does. If there is any standard of care that naturopaths are required to meet, it was as absent as any actual medicine in the homeopathic remedies in the that Dexter thought was were appropriate.

Pertussis is terrifying, but preventable

Vaccine opposition is embedded within the naturopathic philosophy and within naturopathic “medicine”. Nowhere is that more clearly demonstrated than in this sad case, where “natural immunity” was felt to be more important that medical care. I have no doubt that Dexter cares deeply for her children. But all of the suffering that Dexter’s children endured was likely completely preventable, had they been vaccinated. Moreover, had she acted quickly, she could have limited the infection to her oldest child, lessening her suffering, and reducing the very real risk to her other children. But instead, they were all infected. They cried, they coughed, they vomited and they even turned purple. And for what purpose? I have to admit, I’m at a loss to understand this. Writing this post has left me frustrated and sad for three small children who were denied a chance to avoid a horrible illness and months of misery. I guess it simply illustrates how strongly wedded some are to the naturopathic worldview. One in which adherence to a prescientific philosophy seems to trump the obvious suffering of your own children.

Photo via OneSalientOversight via Reddit.