If there's one thing that really animates me and angers me, it's the unnecessary death of a child due to quackery. Competent adults, of course, are perfectly free to choose any form of quackery they wish for themselves or even to refuse treatment at all (which is less harmful than quackery). Children, on the other hand, must trust that their parents or guardians will act in their best interests. When they betray that trust and their duty to act in the best interests of the child, I wonder how this can happen. When there the government sides with the parents, I become even more agitated.

So it was a month ago when I heard about a 19 month old boy named Ezekiel Stephan, who died of bacterial meningitis because his parents relied on quackery to treat him instead of real medicine, and the baby died of his meningitis and an empyema, which is a collection of pus in the pleural cavity surrounding the lungs. Ezekiel's parents apparently didn't even take him to a real doctor, and he died. Not surprisingly, his parents didn't vaccinate him, and it appears likely that he died of Hib meningitis, a vaccine preventable disease, which has led antivaccinationists to claim that the parents, David and Collet Stephan, were being "persecuted" in a conspiracy that would allow Canada to impose forced vaccination on all children, you know, typical stuff.

In any case, the trial is currently on recess and due to resume on April 11, the Stephans having been charged with failing to provide the necessities of life for their son. During the trial, there's been a lot of commentary about the parents and their negligence. Make no mistake about it, no matter how much the parents clearly loved their son, their beliefs led them to medically neglect him, and he died. Instead of taking him to a hospital, they treated him with homemade smoothies, maple syrup, apple cider vinegar, and an echinacea tincture. It was probably the same belief system that led them to work for Truehope Nutritional Support, a supplement company.

What I haven't seen much of is a discussion of the role of naturopaths in contributing to the death of Ezekiel Stephan. For it turned out that the parents sought advice from a local naturopath named Tracy Tannis who practices at the Lethbridge Naturopathic Medical Clinic, who, it was learned, had recommended a "tincture of echinea." Later in the trial, not surprisingly Tannis denied responsibility:

She said on March 13, 2012 her secretary took a phone call from a woman concerned about her young son. She testified the woman told her that she had a friend who was a nurse with her and she was concerned about viral meningitis. Tannis told her secretary: ‘You need to tell her to take the child to the ER right away.'” Tannis testified that the next day a woman came into her clinic and asked for an over-the-counter echinacea treatment for her son who was almost two. Tannis told the court she didn’t know if the woman was the same one who called the day before.

And:

The naturopath has testified she was busy with a patient when Collet called ahead of her visit to the clinic, but that she told a staff member to tell the mother to take the boy immediately to hospital. She said she remained by the phone long enough to confirm the message was relayed, and that she was never asked if echinacea would be a good treatment for meningitis. Under cross-examination, the jury heard the naturopath never told police she had stayed by the phone while the advice was passed on. A worker in her clinic also told investigators she introduced the naturopath to Collet when she arrived at the clinic, and described her as the mother of “the little one with meningitis.”

So it's not entirely clear whether Tannis ever told the parents that they should take their child to the ER. It is clear, however, that she did prescribe some sort of herbal remedy with echinacea to a child with meningitis. When I first read about this, I wondered how on earth anyone could do that. Britt Hermes, an ex-naturopath who couldn't engage in quackery any more explains:

I can guess why this naturopath did not perform a physical exam before she made a diagnosis and dispensed a substance. Naturopaths are trained to work through imaginary cases rather than practice on real patients. I know why the naturopath recommended an herbal preparation even for something as serious as meningitis. Naturopaths, more frequently than not, attempt to treat viral infections and other aggressive diseases with herbs. I often used echinacea for ear infections and colds on my former patients of any age. My former boss was using all sorts of “natural” substances on patients with terminal cancer.

However, she is a naturopath, and that means that, regardless of whether she did the responsible thing or not with respect to Ezekiel Stephan, her entire discipline is quackery, with a bit of sensible advice about nutrition and exercise mixed in to make the quackery seem less quacky. Tannis' website is now down, an Archive.org archive shows that she offers chelation, IV nutrients, IV vitamin C, acupuncture, herbal medicine, ozone therapy, and allergy testing.

Whenever a tragic case like this comes along, it's useful to consider what naturopaths claim compared to what they actually do. I'm referring specifically to the oft-repeated claim by naturopaths that they can function as primary care providers, not just for adults but for children. In Alberta, Canada, for instance, the provinicial government has granted the College of Naturopathic Doctors of Alberta (CNDA) the power to self-govern their profession. Indeed, as Alheli Picazo notes, there is a profound irony here in that, in prosecuting the Stephans, the Alberta government is prosecuting parents who pursued cures from quacks that it licenses and thereby legitimizes. Indeed, Tannis herself graduated from the Canadian College of Naturopathic Medicine in 2003 and is licensed in “good standing” in Alberta. It's thus very scary to consider that, despite the extreme inadequacy of naturopathic training that leads them to treat diseases with ineffective herbs and other interventions, naturopathy as a quack field has the extreme hubris to think that its members can actually deal with the common diseases that primary care doctors see and treat.

All of this brings up the difference between adults and children again. Again, adults can choose whatever quackery they want, including naturopaths, although I would point ou that the state should not facilitate such a choice or otherwise legitimize it by licensing such a pseudoscientific profession. That very same legitimization helps lead parents to think that naturopaths can treat children, too. Granted, in this case it clearly wasn't the fact that Tannis is a licensed naturopath that led the Stephans to think it was acceptable to seek help for their son from her. They are clearly so far down the rabbit hole of quackery in their belief system that it almost certainly doesn't matter either way to them whether naturopaths are licensed. However, to other parents, who might be a bit woo-susceptible but aren't hard core believers, state licensure implies a legitimate profession, which might lower their skepticism.

That's why there are now calls in Alberta for limiting naturopaths' ability to treat children:

University of Alberta health-policy researcher Tim Caulfield says the tragic death is exposing the sharp and dangerous limits of naturopathic medicine. Caulfield, who has long argued that naturopathy operates in the realm of “pseudoscience,” said he’s “sympathetic to the idea of restricting the kinds of services they can provide kids.” “We do a lot of things to protect children and, at a minimum, I get very worried when kids are being taken there,” he said. Alberta licenses naturopaths, as does Ontario and several other provinces, regulation Guichon said gives the field a “cloak of respectability and professionalism” it may or may not deserve.

There's no "may or may not" about licensure conferring legitimacy to naturopathy. It's why naturopaths fight so hard for licensure, because with it comes legitimacy. After the Affordable Care Act, if a state licenses a health care profession, then health insurance companies have to pay for their services, which is yet another reason naturopaths crave state licensure, at least here in the US.