Canadian Nursing Association Resolution to Promote Science Based Nursing and Autonomy Fails

Hi all,

To publicize the fact that nurses are losing professional ground to magical healthcare practitioners here in BC, and that since 2009 nurses have been legally required to take orders from naturopaths, I submitted a resolution to the Canadian Nurses Association as an individual member to protect the autonomy of nursing in future.

I had previously raised this issue with the CRNBC and also with the ARNBC but neither were interested in pursuing it, (CRNBC is solely focused on regulation rather than looking out for the profession now) and it probably isn’t a key priority for ARNBC at the moment due to the ongoing legal battle with the BCNU.

The resolution simply suggested that the CNA advocate that registered nurses (RNs) in Canada not be subject to legislation that requires them to take direction/orders from other health care professions that do not have a superior level of both academic and clinical preparation (that must include Canadian publicly accredited university graduate level academic qualifications, and substantial hospital-based education and training in their field).The full resolution is available here.

This was considered at today’s annual meeting, and after a short debate (4 mins and 35 seconds) it was narrowly rejected by the members. I am not particularly surprised, but am rather saddened that the profession has not taken a simple action that would help strengthen the professional status of nursing in Canada, and protect nurses from further professional exploitation.

The arguments that went against it were mainly from BC (no surprise there) and were:

  1. It isn’t a problem as nurses can always refuse to act against orders given, and
  2. Strong language about using “Canadian” accredited qualifications and “superior levels of qualification” does not recognize the autonomy of other professions and international qualifications.

Vote

  • Yes: 77
  • No: 78
  • Abstain: 0

The point about international qualifications is reasonable. and could easily be included with an amendment such as “or equivalent” but the spirit of the resolution was clear enough, so a shame it didn’t pass with an amendment. Got support from the North West Territories though (yea, go NWT)!

Nurses continue to be at the mercy of political trends that leave new CAM practitioners who gain regulatory status the ability to identify themselves as better qualified than nurses though quackademic credentials. So, far from moving away from the role of “physicians handmaidens” and promoting advanced practice and professional autonomy nurses will continue to be seen as fair game in the Canadian healthcare system to become subservient to any complementary and alternative practitioners who care to call themselves “doctorally prepared” (through whatever means or credential).

So I guess I am to tell my students, you are “autonomous practitioners” in theory, but in the healthcare system at large you are recognized as subservient to anyone who holds a piece of paper that is recognized by the provincial government as some sort of health professional and wants to employ you. It is rather hard to promote a positive role for nursing when practitioners who actually practice magical healthcare and have US based quackademic qualifications are regulated above Canadian nurses. Maybe I’ll get ahead of the game and just set up a course in magical healthcare for nurses for our next undergraduate curriculum revision.

Sad times indeed, and I do wonder what the status of the RN will actually become over the next few years. Looks like reversion to a technical role in support of other health professionals is well on the cards, with the odd restricted role for specialist advanced practice (where the system is under-resourced). So, what happened to the CNAs stated aim to “strengthen nursing and the Canadian health system?”

Bernie

 

 

Small victories for health science with Advertising Standards Canada (ASC)

Hi all,

Thought I would give a quick update on my  experiences using FishBarrel in Canada to target dubious claims and practices, where there is no scientific evidence to support them. I am pleased to report a couple of positive results with Advertising Standards Canada (ASC) for two cases I found recently of CAM practitioners making dubious claims for their practices.

A few weeks back, I almost choked on my toast at breakfast when I opened a local free-newspaper (The Delta Optimist) to find a full page of advertisements with various local CAM practitioners advertising presented as “Ask the Experts” – strangely, with no medical or nursing content. Apart from the nonsense being claimed by some, or blindingly obvious advice (the local naturopath telling people that if they eat healthily they might feel better) what also irked me was that the page was presented as a full-spread editorial exploring healthy living, not a page of paid advertising. I know, I know, I really should know better, and I don’t know why I even bother reading them either – one, a few weeks back had the shocking front-page headline “Tenants Miss Bus!” with a story of a scheduled bus that did not arrive to pick up its passengers; hardly the BBC or Al Jazeera.

Anyhow, I decided to give FishBarrel a test run and complain to the ASC and the Competition Bureau Canada (CBC) to see if I had any luck, and also with another website I had come across making unsubstantiated health claims. It only took a few minutes to make the complaint in the time it took me to finish my coffee.

Firstly, I complained about a BC based self-described dream-healer (who also appeared on TV in 2007 in on the Hour with George Stroumboulopoulos) about his faith/energy/remote healing website. He claimed his therapies were “the most effective way that we can all play an active role in our own healing.” Secondly, I complained about a local craniosacral therapist from the Ladner Birch Tree Wellness Clinic, who claimed that autism, ADD and ADHD, could be relieved with craniosacral therapy. Lastly, I complained to the Optimist had not identified the “Ask the Experts” section as advertising, but implied it was editorial content.

The CBC were not particularly helpful, and somewhat surprisingly, it seems the advertisements did not represent unfair competition (although making false claims for commercial competitive purposes is identified in their standards). However, the ASC response found against the faith-healer in respect to Clause 1 (Accuracy and Clarity) and Clause 8 (Professional and Scientific Claims) of the Code (See: http://adstandards.com/en/standards/adComplaintsreportssearch.aspx and use “Dreamhealer” as the search term in 2013 Q4 to see the ruling)  and initially against the craniosacral therapist in the provisions of Clause 1 (Accuracy and Clarity), and Clause 8 (Professional and Scientific Claims) of the Code – this is currently being appealed by the advertiser so I will update this page on the final ruling). Lastly, it found against the Optimist in  Clause 2 for (Disguised Advertising Techniques).

All of these folks have been written to and required to comply with the code in future and the cases recorded and published on the ASC website. Small beer I know, and overall probably not world-changing, but the more bad-publicity businesses get for employing inaccurate/false claims or unscrupulous advertising techniques the more likely the public are going to question their practices, standards, and motives. All in all, it gives me some hope and was, I must admit, rather satisfying!

I shall be using FishBarrel for more of this in the future, and the more people who complain about this sort of thing the better. I have also just complained to our professional regulatory body (the CRNBC) about a practitioner using their RN status to advertise and support their private commercial CAM practices, so we shall see how that goes. With the Web and tools like FishBarrel it is now quite easy to do this sort of thing, so remember, next time you see unfair, unreasonable or blatantly fraudulent advertising practice you can do the same.

Onwards and upwards,

Cheers Bernie

 Update: March 12th 2014

The appeal process has now completed for the Ladner Cranio-Sacral therapist and the ASC upheld the original complaint finding

“In the opinion of the Appeal Panel, the overall impression conveyed by the advertisement was that craniosacraltherapy is widely recognized as an effective method of treating serious conditions listed in the advertisement. The case studies submitted by the advertiser gave only anecdotal evidence that a few patients believed their symptoms were relieved as a result of the treatment. This, in the Appeal Panel’s unanimous view, is in contrast to the principal claim conveyed by the advertisement.

Because the impression conveyed by the advertisement was not supported by the evidence submitted, the Appeal Panel, therefore, confirmed the original decision of Council that the advertisement contravened Clauses 1(e) and 8 of the Code. “

Happy New Year: the tongue of all our fears…

Happy New Year to everyone.

Roger and I hope the return to work has not been too stressful for all. Given the world failed to end as predicted we have a good set of posts planned for 2013 to further the cause of the understanding of scientific philosophy and rejection of pseudoscience and bad science.

This week I received a copy of McLean’s magazine through the mail. To those outside of Canada  unfamiliar with this glossy periodical, it is basically a version of “Hello” for the “chattering classes” (to borrow Waugh’s term).  I confess now, I am only receiving it now as I got a free three month subscription from my cellphone provider as I am rather a skinflint and couldn’t bring myself to actually pay for a copy.

Anyhow, apart from the usual doom and gloom stories predicting the collapse of the housing market in Canada and the imminent fall off of the Fiscal Cliff stateside, there was an article on Chinese medicine and diagnosis of illness by clinical examination of the tounge.

It described the use of using tongue examination as a standard diagnostic practice used by traditional Chinese medical  (TCM) practitioners and Naturopaths. Apparently by examining your tongue you can diagnose anything from GI problems, allergies, asthma and  some practitioners even claim cancer (OK, not of the tongue – as that would be a tad obvious). There is a website by the Miami TCM practitioner James Rohr explaining the use of this technique and a video of the same. He has even produced a very cool “Tongz” App for smartphones so people can self-diagnose. The argument given is that western invasive diagnostic tools (such as blood lab work or radiography) are expensive and inaccessible to many and that the same results can be obtained by clinical examination of the tongue.

Practitioners make the usual non-science claims for efficacy; i.e. has been used for thousands of years, appeal to the masses (of patients who believe in it), bad western “allopathic” medicine vs good Eastern holistic medicine etc., and explain the  theory behind it being disorders of the flow of the bodies natural “chi” energy with disease processes causing abnormal presentations of the tongue. Quite remarkable really, but to be fair there is a grain of truth (as with many CAM therapies) in this. Unfortunately, there is also a lot of nonsense too.

Clinical examination of externally visible tissues and organs is very much a part of modern medicine. This is an art studied and practised by doctors and nurses, and assessed in their education and training particularly in the notoriously difficult Objective Structures Clinical Examinations or OSCE’s doctors and nurse practitioners have to pass. You can lean a lot by clinical examination. e.g. anaemia indicated by pallor, jaundice indicating liver disease or renal dysfunction, or barrel chest indicating chronic asthma. Indeed examination of the tongue and oral mucosa can give some useful diagnostic information (particularly about oral hygiene standards), but to suggest you can diagnose Asthma from a ridge in the tongue as one practitioner claims, or insomnia is clinical nonsense. There is no evidence base for this, and so far no rigorous scientific studies have been able to identify the presence of any chi energy flow in the body. Indeed, practitioners  explain this as an energy flow that cannot be detected by modern scientific instruments, and so falls into the realms of magical explanation.

That is not to say that there isn’t some form of chi energy flowing through all of us, and that its disorder is associated with disease, and manipulation of it can improve health. Scientific inquiry may simply not have discovered it yet. However, if that were the case we would at least expect some clearly demonstrable results and consistent repeatable instances. What’s more it would seem there is a massive conspiracy by the scientific medical profession to ignore the evidence of thousands of years that we can diagnose a whole range of illnesses by simple examination of the tongue.

What is worrying is that people accept these explanations without questioning this. Naturopaths claim to be (and in many places are accepted as) scientific doctorly prepared practitioners, but then support this sort of mystical nonsense. If it works, why can’t we measure the results and devise a clear set of clinical guidelines for tongue diagnosis that are effective in scientific terms?  This is really the same argument that traditional healers in some countries use when explaining how they diagnose illness by examining the entrails of slaughtered animals (i.e. resorting to magical explanations).

Unfortunately, it just doesn’t work, and if we look at most of the diagnoses made by tongue analysis, they are more easily explained by other more obvious signs. For example I can tell if someone is tired without looking at their tongue (wrinkled skin around the eyes, bloodshot eyes, rubbing of the eyes, yawning, and cognitive slowness) or constipated (by asking when they last had their bowels open) or eats a lot of sugar (by their dental status), or is anaemic (conjunctival and skin pallor) etc.

The diagnoses given through tongue examination are also generally very vague. Frankly, looking at the tounge and claiming “you are tired and eating too much sugar” is not an astounding diagnosis, but claiming it represents a diagnostic science does smack of quackery. That is not to say many TCM and other CAM practitioners are not bonafide genuine practitioners, who actually believe in this stuff, and I am sure many do. But, I must admit when I see CAM holistic practitioners championing natural traditional therapies, with cool websites, awesome tans, and enough cosmetic dental work  for my local dentist to retire to the Bahamas, I do being to ask “what is the probability…”

Bernie

References

Eckler, R. (2013) Tongues are Wagging, Maclean’s Magazine, January 14

http://www.jamesrohr.com/