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. “

Climate Change, Evidence and Back-Passages

A little while ago I attended a lecture at the university by an ex-speechwriter for Tony Blair. For those with short memories Blair was the Prime Minister in the UK pretty much throughout the first decade of the 21st century. In this particular lecture he addressed the global economic changes that were taking place, the fact that Europe was old, dead and buried, that the future belonged to China and that Blair and everyone subsequently, had got everything wrong. He alone had the answers and these were available in his new book…blah…blah…blah…

I hate to be hypercritical but I did think that his presentation, whilst so polished that I could almost see the reflection of my grimacing face, was pretty vacuous really, but then he said something, as a throwaway line, that I thought was terribly interesting and profound and has stuck with me ever since. He mentioned that when he had been in the inner echelons of political power he had come to realise that “politicians don’t do evidence, they do narrative”.

This lecture was before the arrival of the present government, but I doubt if much has changed. In the UK at the moment we have a coalition government formed by two political parties, the Conservatives and the Liberal Democrats, the main opposition party being Labour. They are curious bedfellows as the Liberal manifesto was undoubtedly to the left of Labour’s, yet they find themselves governing with a centre right party (many of whom would want the word ‘centre’ dropped). This partnership has led to the Liberal’s dropping a number of key policy ideas and commitments and to the Conservatives losing err… well not much really.

Most infamous amongst these for the Liberal’s was a very public commitment to no tuition fees in English Universities. This was dumped as soon as they came to power, with the sort of indecent haste that poses all sorts of questions about the true motivations of politicians. Now I am really trying to remain (sort of) neutral here and not just attack the Liberal Democrats as some sort of disillusioned voter (although I am) but rather to analyse some of the decisions that have been made subsequently since the formation of the government.

Let’s take Carbon. The UK has rigorous targets for CO2 reduction and has in fact reduced Carbon emissions by 10% in the last decade. Hoorah, Hoorah! Although some of that is almost certainly due to production moving overseas, in fact if you take that into account CO2 emissions went up! http://www.bbc.co.uk/news/business-22267231

Boo hoo! Boo hoo!

However, despite the United Nations recently stating that it is (95%) certain that Climate Change is anthropogenic and the serious weight of academic scientific evidence for this, the UK government is looking at ‘opting out’ of its CO2 reduction targets. Now the reasons for this are that the UK would be at a disadvantage compared to the rest of Europe and that the Government want to fill the predicted energy gap with a new generation of Gas Powered power stations. So despite the increasingly dire warnings concerning climate change, the scientific evidence is simply ignored. Economic growth (at seemingly any cost) is the paramount consideration.

This is despite the following quote from the Liberal Democrat manifesto for the last election:

“We now know, from climate scientists, that the next government will be the last that can stop dangerous climate change.”

This year (2013) they ditched their opposition to Nuclear Power and the Liberal Democrat Secretary of State for Energy is just about to sign-off on the construction of the first new nuclear power station in the UK’s new nuclear program. They argued their support for nuclear power was to reduce CO2 emissions. OK, but at the same conference they decided that fracking is a good idea and now wholeheartedly support it. This is the party that recognised that they are the last government to stop climate and yet they support fracking!

http://www.bbc.co.uk/news/uk-politics-24100833

To be fair, the Conservative are even worse and I doubt if Labour had won, much would be different. ‘Politicians don’t do evidence’.

Now it seems to me that scientists may have a role to play here. Back even further in time, a Conservative government had to deal with the arrival of HIV/AIDS. It was in the 1980’s when Margaret Thatcher was in power. Thatcher was so appalled by the idea of anal sex that according to the then Health Secretary’s diary she actually wanted it referred to as ‘back passage sex’ in any government information leaflets. Apparently, it was health professionals and senior clinicians who managed to talk the government into taking any action at all (she agreed to drop the term back passage sex when it was pointed out that this may be misconstrued as vaginal sex in an alleyway). The point being that the health community really pushed the evidence and eventually the government had to act.

We can’t push the evidence of climate change any harder, yet in the UK at least, we seem unable to influence policy. Economic considerations (and for the cynics – vote winning) seem to take precedence.

So, OK governments ignore scientific evidence. Governments have every right to – we live in a democracy, not a technocracy. However, every time they do so, they always question the science. Is global warming really anthropogenic? Is burning gas to produce electricity really that energy inefficient? Can we really provide 50% of our electricity from renewables? The answer to all of the above is yes by the way. Ignoring the evidence by doubting it, however tenuous and manufactured that doubt is, may be politically expedient, but it undermines the science. It would be far more appropriate (and honest) to accept the evidence, but then to state why they have decided to ignore it. It may well be for economic reasons, jobs, cheaper options, infrastructural investment, whatever, but it doesn’t challenge the science.

In an ideal world any government decision that choses to ignore overwhelming scientific evidence should have to be explained in this way. We should constantly be asking of our politicians ‘why are you ignoring the evidence?’ Or, in a way that gives them more room, “what evidence is your decision based on?”

We often talk about evidence-based practice, perhaps it’s time for our politicians to be encouraged to adopt similar methods, before we all end up a back passage.

Roger (Bernie posted this for me due to network issues)