On assisted death and psychological suffering

This column was published at Maclean’s on March 28, 2017

In 2015, a landmark ruling by the Supreme Court of Canada struck down the federal ban on physician-assisted suicide, solidifying the charter right of competent, consenting adults who are “suffering intolerably as a result of a grievous and irremediable medical condition” the right to die on their own terms with medical assistance.

Criminal prohibition on assisted-death, the unanimous Carter v. Canada decision noted, condemned the “grievously and irremediably ill … to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.”

That callous dilemma was rectified only in part by the assisted-dying legislation put out by the federal government in June, which restricts physician-assisted death to “grievous and irremediable” illness where natural death is “reasonably foreseeable.” In effect, the law prohibits assisted-death beyond the end stages of terminal disease, a limit that defies the underpinnings of the Carter ruling and fails to provide medical professionals with straightforward criteria or substantive guidance on this delicate matter.

The instinct to prioritize extreme physical suffering above all else is a deeply human tendency. Even without first-hand experience, people can relate to tangible pain. Compassion is natural. But abstract torment—the sort of ongoing suffering caused by an unquiet mind—garners far less empathy and even scarcer latitude. However unsettling it is to discuss, it is time for honest, open dialogue to begin on the matter of physician-assisted death for psychological disease.

Where the government’s narrow approach to assisted-dying has sown confusion and doubt around patient eligibility and physician liability, the distinct exclusion of psychological suffering further compounds uncertainty, as it inadvertently establishes an hierarchy of disease and opens the extent and validity of another’s suffering to broad debate. When the legitimacy of an illness can be arbitrarily called into question, people living with proven-irremediable torment will be denied their charter right to die simply because their anguish stems from a disrespected diagnosis.

The government will at some point, by choice or by force, amend its assisted-dying legislation which, in its current form, has been deemed unconstitutional by Peter Hogg, Canada’s foremost authority on constitutional law. When the required independent review regarding the scope of eligibility reports back in 2018, a comprehensive understanding of mental illness will prove crucial to making the law right.

Though significant gains have been made in demystifying mental illness and eroding the stigma attached to various diagnoses, there remains a reluctance to candidly discuss, or even admit to, an uncomfortable reality: As is the case for any severe or chronic health condition, for some, recovery from mental illness simply will not happen—not for lack of effort or will, mind you, but because the brain cannot right itself. Be it unrelenting depression or ruthless OCD, psychiatric disorders which prove not-responsive-to-treatment can, like a terminal cancer, slowly destroy the individual without mercy and without reprieve.

A point will be reached where there is little, if any, quality of life, and deterioration will only continue. It will not get better because in those specific, extreme cases, it cannot get better. Though painful to confront, this truth cannot be ignored. It’s key to understanding the true nature of mental disease.

To date, medical conversations around aid in dying have largely omitted this component of psychological illness. In arguing against assisted-death for psychiatric suffering, Euthanasia Prevention Coalition (EPC) president Jean Echlin insists: “If somebody loses their life now, they’re put to death, and two weeks from now there’s a breakthrough, they’ve lost their life when they could have had quality.”

But that’s a false premise. In making that argument, the EPC and similar organizations appeal to a misplaced faith in some imminent, miraculous recovery. They endlessly debate what if scenarios because they refuse to acknowledge the distressing reality of what is.

Forcing someone to exist for decades in what amounts to an excruciating purgatory is no morally or ethically superior than granting those living a ceaseless hell some control over their circumstance by allowing the option of a merciful end should they, at some point, choose.

Because, to be clear, these individuals will end the pain. Bioethicist Udo Schuklenk, who chaired the Royal Society of Canada’s 2011 panel on end-of-life decision-making, confirms “a large number” of those suffering from intractable mental disease will “at one point or another commit suicide, and it often happens in terrible circumstances”; these methods often further traumatize those left behind. Physician-assisted death offers “a better way for them to end their lives,” and provides a peaceful, controlled conclusion, where no loose ends remain to painfully fray. In this sense, state-facilitated “suicide” is a form of harm-reduction.

There’s understandable apprehension about “normalizing” suicide or being seen as encouraging—or worse, glorifying—death over treatment and recovery for psychiatric suffering. But suicide and assisted-death are two entirely different phenomena and should not be confused.

As the Centre for Suicide Prevention notes, suicidal urges are temporary and the act itself is one of desperation. At their point of crisis, a suicidal person “cannot see alternatives to their situation beyond death.” They do not want to die, but they lack the means to help them live. “Given help,” the CSP says, “they will choose help”; with proper intervention, recovery is not only possible, it can be expected.

Those qualifying for assisted-death explicitly want to die. They have sought and exhausted all available medical resources, and further treatment would not yield results. With no prospect of recovery or further improvement, their decision to die would be neither rash nor ill-considered, but carefully planned and, if carried out, done so mindfully.

A proper framework for assisted-death in cases of physiological suffering would see final approval granted to those who undoubtedly qualify while safeguarding the most vulnerable. Stipulating alternative pathways be encouraged throughout the screening process and mandating meetings with medical and psychiatric professionals who would offer the proper course of treatment to those who perhaps, to that point, had gone without or were unable to access it could, over time, save lives.

The right to assisted-death needn’t supplant or replace proper mental health funding and treatment, either. Where already available, in cases of terminal disease, aid in dying doesn’t replace or supersede comprehensive palliative care, but serves as an option in addition to it.

An excruciating life voluntarily cut short is undeniably tragic. So too is condemning others to an unending misery because the distress of those uninvolved—over the mere notion of an alternative—is deemed the greater bother.

 

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Carleton’s unbalanced approach to wellness

This op-ed appeared in the Ottawa Citizen on March 14, 2017.

It’s hard to overstate the naïveté at the heart of Carleton University’s initial decision to remove the scale from its fitness room at the athletic centre.

The move, ostensibly “keeping with current fitness and social trends,” sought to promote a “more holistic” approach to fitness, body image and overall wellness by discouraging focus on weight. (In an email update Tuesday, however, Carleton said scales have now been put in the change rooms.)

Contrary to some reports over the heated debate sparked by the university’s decision, the scale’s initial removal wasn’t prompted by any specific request or complaint, but was an independent choice of the recreation and athletics department.

“We don’t believe being fixated on weight has any positive effect on your health and well-being,” Bruce Marshall, manager of health and wellness, told Carleton’s student-run paper, The Charlatan. “It takes weeks, even months to make a permanent change in your weight. So why obsess about it?”

Marshall, without a hint of irony, offered other numbers on which anxious gym-goers should fixate: “You can start by recording measurements in multiple areas, for example your torso, hips, chest, legs and arms. You would then revisit these measurements after a few weeks to keep tabs on your progress.”

He also suggested “the best indicator” in measuring success “is how well you feel in your body.”

Setting aside the comparative limits in tracking girth versus tracking weight – neither can provide any significant gauge of fitness, as neither separates the lean body mass from fat mass in those numbers – to advise success be measured in terms of self-perception speaks to lack of thought behind the attempted culture shift.

Recent years have seen a rise in this “body positive” approach, where emphasis is placed on learning to love your body and all its imperfections. This is not, at its heart, a bad thing. It offers permission to be flawed, and provides comfort in being human.

However, determining fitness-related progress by “how well you feel in your body” is a terrible strategy. Being remarkably lean and muscular, having a body others might envy, for instance, doesn’t magically translate to confidence, self-worth, or any real sense of accomplishment. Relying on “feeling” as a marker of success in the gym can be a route to self-destruction, and no less so than obsessing over numbers on a scale.

Tangible, reliable methods of tracking success in health and fitness are essential to sustained progress and maintained well-being, both inside the gym and out. While an imperfect tool, the scale serves as an easy, reliable motivator and monitor.

And while most associate the scale with the quest for weight loss, it’s essential for those whose goals in the gym include gradual, sustained weight gain.

It’s entirely normal to approach a scale with some hesitation. Having an unhealthy relationship with the numbers that appear, however, to a point where it interferes with daily life – where it consumes all one’s attention, drives irrational dietary habits, causes relentless anxiety – is a problem, and not one that is solved by the scale’s disappearance.

If there’s genuine concern over those struggling with body image or eating disorders in relation to the scale, then provide a list of resources, such as psychological and nutritional counselling, support networks and peer groups, one-on-one consultation on making goals and tracking progress, next to the scale, rather than removing it altogether.

There are far better ways to cultivate a more welcoming, well-rounded atmosphere for gym-goers than the athletics department initially chose.

And the increasingly hostile sniping between sides over the merits of the scale suggest the university has only served to create an even more unsympathetic environment for those already unsure of taking part.

 

Expanded thoughts, if interested: Learning to live with the body you’re in 

On Homeopathy, Health Canada Must End The Double Standard

This column appeared on the CBC on December 11, 2016.

Until recently, homeopathic remedies sold in the United States enjoyed many of the same privileges — including the freedom to claim they could treat or cure specific ailments or diseases — as real, science-based medicine. The difference? Peddlers of homeopathy weren’t required to provide the Food and Drug Administration (FDA) with any evidence whatsoever to substantiate the miraculous therapeutic claims their products made. The same has largely been the case in Canada.

It was an abhorrent oversight by agencies tasked to protect consumers’ well-being, and one that only now being addressed by the Federal Trade Commission (FTC). In a statement issued last month, the FTC announced that homeopathic remedies, like all medications sold, must provide “competent and reliable scientific evidence” for all health-related claims, including, most importantly, “claims that a product can treat specific conditions.”

New labels

Absent that, in the U.S., homeopathic drugs will have to wear a label indicating that: “1) there is no scientific evidence that the product works; and 2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.”

Homeopathy is, as Steven Novella, academic clinical neurologist at the Yale University School of Medicine, unambiguously describes it, an “unadulterated pseudoscience … a prescientific medical philosophy.”

Its underpinning theory is that “like cures like.” Homeopathic drugs are made using trace elements of substances that cause symptoms in healthy people. Those elements are then diluted entirely out of existence, priced at a premium and sold as inert “remedies.” Infinite dilutions of poison ivy would be sold as the treatment for a persistent itch or chronic rash, for instance.

The idea is that water carries a “memory” of substances it has come into contact with — a theory that defies the basic principles of biology, physics, and chemistry. To find a single molecule of active substance in a 30C homeopathic solution (the dilution level of many over-the-counter homeopathic treatments), for instance, American physicist Robert L. Park notes you’d require a container of water greater than 30,000,000,000 times the size of the Earth.

Homeopathy is a lucrative business: we’re talking one where American consumers spend in excess of $3 billion per year. Yet the most comprehensive evaluation of homeopathy to date — a review of evidence from 225 studies, which met the required rigour of some 1800 published papers — concluded “there is no reliable evidence that homeopathy is effective for treating health conditions.”

The ‘natural’ choice

No amount of evidence will be sufficient to sway those hopelessly indoctrinated into pseudoscience, but many who turn to alternative medicine are driven by honest misunderstanding of how the body functions and how medicine works. Some are also driven by the appeal to nature — a seductive fallacy which argues that “natural” is inherently good, therapeutic, and pure — based on the notion that homeopathy is a natural choice.

Yet “natural” versus “synthetic” is a fundamentally false, meaningless comparison. Raspberry ketone, for instance, a purported natural “miracle fat-burner,” is a chemical extracted from various fruits and berries. It can also be synthetically made, then known as p-Hydroxybenzyl acetone. But whether “naturally sourced” or synthetically derived, it’s still C10H12O2 — a single chemical, with a set arrangement of atoms that behave in the same, identical manner. Not one, mind you, that involves “miracle fat-burning.”

That’s likely too esoteric for the average consumer, but clear labels indicating a lack of scientific backing surely is not. Canada, however, has only gone so far as to require labels for nosode products (which are touted as vaccines) and homeopathic remedies for cough, cold and flu marketed to children 12 and under. Everything else can stand on pharmacy shelves, right next to legitimate medicine, and sold as fanciful medicinal alternatives. Fortunately, Health Canada has just recently signalled that it’s ready to start cracking down on claims that have not be scientifically proven.

Health professionals have been in the trenches of this dystopia for some time — their fight for reason made increasingly difficult by governments’ own normalizing of pseudoscience. Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta, has rightly called for Health Canada to follow the FTC’s lead in requiring proper labelling to “ensure the Canadian public gets scientifically accurate information about the health care products and services they are buying.”

This isn’t complicated. Holding practitioners of alternative medicine — and the products they sell — to the same rigorous standards we apply to physicians, pharmacists and all other certified healthcare professionals is certainly not asking too much. If the U.S. can do it, why can’t we?

 

Re: Death By Pseudoscience – The Misinformation Campaign

First, a quick review of the facts:

David and Collet Stephan are on trial for failing to provide the necessaries of life — for failing to seek medical care for their son in a reasonably prudent time/manner. They are NOT on trial for murder or manslaughter.

Ezekiel Stephan died from bacterial meningitis, the kind which is vaccine-preventable and when promptly and properly treated, can be fully recovered from.

The child did NOT have viral meningitis

.

The bacterial meningitis was at such an advanced state by the time Ezekiel finally reached hospital, he was clinically brain dead and sepsis was coursing through his bloodstream; the post-mortem revealed pus on his brain, in his spinal fluid, and on his right lung.

These facts are 100% knowable, and known, and irrefutable. People lie, autopsies and medical reports do not.

The child’s health deteriorated for weeks: he was displaying neurological abnormalities (likely small seizures) and was neither eating nor drinking, but sustained through an eyedropper, as the parents stuck to the “game plan” they’d drafted to “use as many natural things” as possible before resorting to proper medical intervention.

As Ezekiel lay dying in hospital, his parents were defending the efficacy of their plan.

The CBC reports:

Asked by the officer whether he considered himself an expert in naturopathic remedies, Stephan said no.

“Do we have a formal education? No. Are we educated in it? Absolutely,” he said. “Has it worked for us in every single scenario in the past before this? Yes.”

Ezekiel was regularly given vitamin and mineral supplements, said his father, who is a vice-president of Truehope Nutritional Support Inc., a natural remedies company founded by his father, Anthony Stephan.

“And then when he was sick there, we were giving him, above and beyond that, the olive root extract, which is an antifungal, antiviral, it’s a very powerful one.”

The mother told investigators that the nurse-friend she called to check on Ezekiel advised he was showing symptoms of meningitis, and yet she ignored the friend’s advice to take the child to see a medical doctor. 

Instead, Collet “went online and researched meningitis … and it looked like he had about 95 per cent of those, the symptoms of a viral meningitis.”

Again from the CBC:



The mother told the officer she immediately started giving Ezekiel natural antibiotics and anti-inflammatories, along with a product called Total Reload, “which is filled with electrolytes, vitamins … and amino acids that are already a broke-down form of protein,” she said.

“And so we started getting that into him immediately and he started to improve very quickly.”

Total Reload is one of several natural supplement products sold by Truehope Nutritional Support Inc.

That “improvement” included his body being visibly contorted and too stiff to sit in his car seat when they sought out the Naturopath and purchased an Echinacea mixture to administer to the child.

Ezekiel was given another Truehope product called Empowerplus which, according to the father, “had obviously a profound effect on him, and he was doing great, he ended up going right to sleep and it was a completely relaxed sleep, he was no longer arching his back.”

No longer arching his back, and soon, no longer breathing.

The Stephans called 911 twice — with a 23 minute gap in-between. For a full 23 minutes after Ezekiel first exhibited signs of respiratory distress – the father counted 5- and 6-second gaps between breaths – the Stephans opted to ‘wait and see’ as Ezekiel struggled to breathe for nearly a half-hour.

Ezekiel did not die from lack of oxygen, nor was his brain affected by time in Ambulance without a properly fitting face-mask. The child was being worked on by paramedics the entire time.

Brain death from oxygen is markedly different from brain death from meningitis, and both the CT scan in hospital and autopsy conformed there were NO signs of brain damage or death from oxygen deprivation.

The child died from “a cardiac arrest secondary to what was likely a hypoxic event because of his overwhelming bacterial meningitis.”

Further to Ezekiel’s diagnosis and likely state of health, a paediatrician explains:

Dr. Adeagbo concluded that Ezekiel died from both bacterial meningitis as well as pneumonia with an accompanying empyema. Empyema is typically diagnosed in the setting of a bacterial pneumonia when pus collects within the lining of the lung.
So what does this mean? It certainly makes sense from a clinical perspective. Ezekiel likely developed bacterial pneumonia caused by infection by either S. pneumo or HiB, which went untreated and developed into an empyema. At this point surgical drainage is usually necessary for recovery in addition to appropriate antibiotic treatment. His bloodstream was repeatedly showered with the pathogenic bacteria, which eventually made its way to the child’s brain.

This new information adds to my suspicion that Ezekiel was much more ill-appearing than described by his parents and the nurse who visited the family’s home. Although there may have been some degree of waxing and waning of his symptoms, particularly with the fever he almost certainly developed during the course of his illness, I am very skeptical of claims that he had any significant recovery just prior to his arrest. This also makes it more likely that he suffered a great deal prior to his death.

Those who’ve been following this case will be familiar with the aggressive misinformation campaign mounted by the Stephans and their apologists/supporters.

A few to note:

Karen Selick, who I’ve touched on before.

Selick is acting as part of the Stephan’s PR campaign, and her connections to Anthony Stephan and Truehope go back to 2004 (more of her beliefs in dubious alternative health treatments are detailed here as well.)

She has a long history of working along side a man named Shawn Buckley — president of the Natural Health Products Protection Association (NHPPA – an alt-med/health lobby) and defence lawyer for David and Collet Stephan.

He previously represented Truehope/Anthony Stephan in the fight with Health Canada.

Buckley was supposed to be at a recent Total Health Show in Toronto, but couldn’t attend due to the trial. 

Selick was there, though, and distributing photocopies of her (now pulled) op-ed for the Lethbridge Herald (a nearly identical version still appears on Huffington Post Canada) where she lies about my column for the National Post and about the case itself.

Danielle Smith had Selick on her radio program to repeat a number of untruths about the case, completely unchallenged.

Smith later hosted a man named Ian Stewart to present the “other side” of the story.

Stewart is Vice-President of the NHPPA and Director of Regulatory Affairs for Truehope.
He is also the one behind the Stephan’s Stand 4 Truth blog where he offers a skewed interpretation of events from the trial.

Stewart was on Smith’s show – again completely without question – to misinform about the case and push the defence’s big ‘bombshell.’
Both Stewart and Selick (with many thanks to Danielle Smith) were instrumental in pushing the, as described by another member of the Stephan family:

Massive massive system shaking scandal coming out in court tomorrow as Albertas Recently retired Chief Medical Examiner testifies AGAINST the crowns star witness and the Provinicial Government specifically regarding this case!!!!!!!!!! Massive cover up!!!!!!

Here’s what you need to know about Dr. Anny Sauvageau:

Her qualifications and credentials have come under scrutiny before. She is not board-certified or trained in forensic pathology, nor does she have license to practice medicine in Alberta.

She did not, at any point, examine the child and her nonsensical testimony and blatant misreading of the autopsy would have medical professionals calling for her to be stripped of her medical license — but she doesn’t have one.

There’s much, much more to write about the many players involved in this case, the multitude of conspiracy theories they’ve concocted regarding the trial and the case itself, and the trail of lies from all involved which, thanks to testimony from medical professionals and recorded police interviews, have been exposed as such.

For now, however, just be aware of what you’re being sold when you’re presented with other versions of this tragic story, and by whom.

Legitimizing Pseudoscience: What’s The Harm?

This column ran in The National Post on March 24, 2016.

(Response to Karen Selick’s lies found below this piece)

After weeks of trying “natural” extracts and homemade remedies like smoothies cut with ginger root and horseradish to cure a suspected case of meningitis, 19-month-old Ezekiel Stephan’s tiny body had so deteriorated that he was too stiff to bend. Unable to be sit in his car seat, Ezekiel’s parents, David and Collet, loaded a mattress into the back of their vehicle to take him to a health practitioner — not a doctor.

They planned to drive to Lethbridge, Alta., to visit a naturopath, whose clinic they’d contacted days earlier in search of something to “boost Ezekiel’s immune system.”

Only after their son stopped breathing did the Stephans think it wise to call 911. In a desperate bid to save time, they drove to meet the ambulance, performing CPR en route. According to Collet, Ezekiel “was blue by the time we met up.”

Now on trial for Ezekiel’s death, the Stephans pleaded not guilty to the charge of failing to provide the necessities of life, maintaining they’d pursued a legitimate, alternative course of treatment. And for those immersed in the pseudoscientific realm of “alternative health care,” this, indeed, seems to be a perfectly reasonable defence. The same government that is now prosecuting the Stephans has also granted the College of Naturopathic Doctors of Alberta (CNDA) the power to self-govern their industry — in essence, the state is now prosecuting parents for pursuing cures from a modern-day snake-oil industry that it licenses and legitimizes.

When it granted the CNDA its powers back in 2012, Health Minister Fred Horne said that he and his fellow elected representatives “believe the practices that will be engaged in by (naturopathic) professionals are safe and effective and meet the highest possible standard.”

Dr. Allissa Gaul, founding president of the CNDA, boasted the decision meant that “Albertans can have confidence … they have a Naturopathic doctor who meets stringent competency and practice requirements.”

It’s worth noting Dr. Tannis, the Naturopath who prescribed Echinacea for a child suffering a life-threatening illness, graduated from the Canadian College of Naturopathic Medicine in 2003 and is licensed in “good standing” in Alberta. (In court, she said she told the Stephans to take their child to an emergency room.)

The profound suffering and preventable death of Ezekiel has rightly provoked heated discussion about the validity of so-called alternative medicine, prompting finger-pointing toward all who enabled and abetted the long deterioration and ultimate death of a toddler whose ailment was both vaccine-preventable and entirely treatable.

One thing is clear: Ezekiel is a casualty of pseudoscience; his death facilitated by the allure of alternative medicine.

Naturopathy, for instance, is not a form of medicine, but a system of belief; its approach to treating illness reliant on the theory of vitalism. That is, disease is viewed as being caused by an imbalance of vital forces and, thus, the treatment rests in the restoration of those forces.

Despite its claims to ancient roots, naturopathy was invented by Benedict Lust, a German immigrant to the United States and self-proclaimed “doctor” who was ultimately convicted for practising medicine without a licence. To this day, many procedures on its standard list of practices and cures have not passed scientific muster.

Naturopathy relies on dubious diagnostics — hair analysis and IgG Food Intolerance screening, for instance — to identify non-existent deficiencies or fabricated ailments. The prescribed interventions, conveniently, are on hand and sold directly by practitioners.

Treatments range from the proven-ineffective and largely innocuous, such as Vitamin C infusions and herbal supplements, to the far more dangerous and potentially fatal ozone and chelation therapies.

Naturopathy preys on the critically and terminally ill by peddling false hope and sham treatments with exorbitant financial and emotional costs; it fuels scientific illiteracy by accommodating those who misunderstand or distrust legitimate medicine, prescribing futile detox and cleanse regimens.

Naturopaths endanger public health by agitating against vaccination, selling homeopathic nosodes, which, to be clear, are entirely inert.

As Timothy Caulfield, professor in the Faculty of Law and the School of Public Health at the University of Alberta wrote in 2013: “There is no evidence that homeopathy works, and given the absurd nature of the proposed mechanism of action, no scientifically plausible reason that it should work.” None.

Although homeopathy was not prescribed in Ezekiel’s case, it remains one of the central tenets of naturopathy. And when governments capitulate to the demands of a pseudoscientific lobby, as Alberta did in 2012, such nonsense is granted authority.

Though undoubtedly lucrative, embracing and incorporating magical thinking into the realm of evidence-based medicine is both ethically questionable and professionally irresponsible.

If naturopaths, homeopaths, osteopaths or any of the numerous “natural” or “holistic” practitioners want to be regarded as heath-care professionals and afforded the same respect, opportunities and privileges earned by those working in the evidence-based medical system, they must agree to be held to the same standards in terms of education, certification and efficacy of their prescribed treatment.

Until the alternative health industry is required to demonstrate the validity of its existence, the corpses that refute it will continue to mount. And all who overtly or indirectly enable the spread of pseudoscience share the blame for the casualties.

 

————

 

On April 2, the Lethbridge Herald published an incredibly irresponsible and non-factual response to my column written by Karen Selick, a woman who is involved with the alternative / naturopathic (and conspiracy-minded) industry, and who has received financial contributions from Naturopaths for her raw milk lobbying efforts. She has also appeared at numerous naturopathic/alt-med conferences and events.

She believes Monsanto (glyphosate, in particular) is the cause of autism, along with along with vaccines, of course. She is a strident anti-vaxxer and thinks there’s a global conspiracy (thanks Big Pharma!) to prevent people from accessing natural remedies for things like cancer. (see bottom FYI for more)

Below is a line-by-line correction of her op-ed, ironically titled Clearing up factual distortions

Everything bolded is mine

——

The National Post recently published an opinion piece that exemplifies how moral panics get started.

If by “moral panic” Selick means “necessary scrutiny of an industry which, at this moment, claims (among other things) that cancer has an “emotional cause” and is cured by proven-ineffective (and expensive) ‘alternative’ methods,” then OK.

Alheli Picazo’s March 24 article, entitled “Alberta Shares the Blame” (the online version was called “When naturopathy kills”), dealt with a criminal prosecution currently before a jury in Lethbridge. David and Collet Stephan have been charged with failing to provide the necessaries of life to their son Ezekiel, who died in 2012 of meningitis.

Correct. Also: I do not write the headlines.

So far, only the prosecution has called witnesses. The case stands adjourned until April 11, when the defence will begin. But Picazo has already rushed to judgment.
She calls Ezekiel’s death “preventable” and labels him a “casualty of pseudoscience.”

Yes. Ezekiel’s death was 100% preventable, and yes, as he did not receive the vaccination to prevent the form of meningitis he died from, nor did he receive legitimate medical care before it was too late to allow him to be treated for, and recover from, said meningitis  (due entirely to his parents’ extreme anti-vax stance and belief – and personal business – in “holistic” remedies) he was a casualty of pseudoscience. 

More on the Stephan family business HERE 

Very thorough (and unvarnished) reading on this from evidence-based medical perspectives HERE and HERE

HERE and HERE are just a pair of examples of the father’s anti-vax musings. HERE and HERE from the mother. 

HERE is the father on an anti-vax radio show pleading his case 

Here are the “facts” as Picazo placed them before readers:

“After weeks of trying ‘natural’ extracts and homemade remedies like smoothies cut with ginger root and horseradish to cure a suspected case of meningitis, 19-month-old Ezekiel Stephan’s tiny body had so deteriorated that he was too stiff to bend. Unable to sit in his car seat, Ezekiel’s parents, David and Collet, loaded a mattress into the back of their vehicle to take him to a health practitioner – not a doctor.”

Those parents must be monsters, right? Actually, no. What’s monstrous is the number of factual distortions that Picazo packed into a single paragraph, with not even an “alleged” kicking around to hint that there might be another side to the story.

Notice not a single “factual distortion” was directly pointed to… because there are none. These are knowable – and known – facts. That Selick has decided she doesn’t want to believe said facts doesn’t make them any less true or warrant the addition of “alleged.”

There is no ‘other side’ to a ‘story’ here. 


Ezekiel’s “suspected meningitis” did not go on for weeks. He had started exhibiting symptoms of a cold, or at worst croup, around Feb. 27, 2012. Over the next two weeks, his symptoms disappeared and returned twice, sometimes appearing like flu, but never including seizures or rash.

Actually, yes. The meningitis did go on for weeks. In February, when Ezekiel first started showing signs of illness, his parents thought it was a croup. And it was a steady deterioration from that point – from the bacterial meningitis – until his death. 



Further, “never including seizures or rash” is meaningless.

It was not until March 12 that a family friend – a nurse who coincidentally knew that there had been a recent case of meningitis in her hospital – mentioned the possibility of viral meningitis. But based on Ezekiel’s mostly asymptomatic condition that day, she said, he’d probably be turned away from a hospital emergency room.

No, that’s not what the nurse-friend said. She told the parents to take Ezekiel to see a doctor.

The parents chose not to, and in their re-telling of the story now, they’re claiming (and allowing others, like Selick, to claim) they’d have been turned away ‘because our socialist healthcare system does that.’



Those were not the nurse-friend’s words.

Picazo makes it sound as though Ezekiel was getting progressively stiffer over a period of weeks until he was loaded rigor-mortis-like into the car to visit a naturopath.

Yes, that’s because he was. Those are the facts, and entirely knowable based on the autopsy.  

Here is a thorough read of this from one who knows.

In fact, on the morning of March 13, he had been in his car seat, perfectly able to bend.

No, that’s not a fact. It’s a flat-out lie, actually. The parents’ own statements to RCMP (played in court) refute Selick’s assertion.

But he was cranky and uncomfortable, so rather than aggravate his distress, they removed him from the car seat and let him lie on his foam crib mattress on the back seat.

“Crib mattress”. That’s cute. No, it was not a crib in any way. It was just a mattress and the parents never attempted to present it as anything but.

When a crisis arose that evening – Ezekiel temporarily stopped breathing – his parents called 911 and set out for the hospital. Picazo says, “Only after their son stopped breathing did the Stephans think it wise to call 911.” But wait – 911 is for emergencies. People who call 911 because their kid has a cold can be fined up to $10,000 in Alberta for making a frivolous call.

Yes, 911 is for emergencies — as in a deathly-ill child. Can Selick point to any case where a person suspecting their child needed medical attention (even if it were a simple cold or flu) called 911 and was subsequently fined/charged?

Nope.

The unfortunate truth that Picazo omits is that meningitis is an illness that can strike suddenly and kill within a day or two. Usually, the symptoms progress very quickly from bad to worse. Ezekiel’s waxing and waning cold symptoms are not typical, and might indeed have indicated nothing other than a cold at that time.

There was no omission. I have a word count to adhere to. I’d love to have gone into great detail about the illness itself.

Also: the “Ezekiel’s waxing and waning cold symptoms” line is, again, intentionally misleading. Ezekiel’s symptoms were not mere cold symptoms, and the extent to which they fluctuated is in doubt.

Again: Autopsies don’t lie. (See above hyperlinks to physician/surgeon SBM writers)

(More on the symptoms according to testimony) 

The Meningitis Research Foundation of Canada’s website contains dozens of stories of meningitis cases that killed or seriously disabled their victims within days. In numerous cases, doctors had examined the victims not long before and sent them home with diagnoses of cold, flu, food poisoning, ear infection, gastroenteritis, pneumonia, etc.

And here Selick reveals her true motivations. She is an activist against the Canadian medical system, and is a documented agitator against ‘socialized health care.’ She regularly pulls the “but doctors make mistakes too! Hospitals kill too!” line to distract from scrutiny of the alt-med industry — one to which she belongs and believes in religiously.

(The Stephans use the same tactic)

The only definitive way of diagnosing bacterial meningitis is a spinal tap in which fluid is drawn from the spinal cord and tested. This excruciatingly painful procedure exposes patients to additional risks. Doctors do not ordinarily inflict it upon patients who appear to have merely colds or flu.

Yes, a spinal tap is a necessary diagnostic procedure, because that’s how real medicine works. And no, it’s not “excruciatingly painful.” It’s uncomfortable yes (I’ve had a few) and gross to think about if you’ve never had one, but nothing more.

And again: Ezekiel was not simply ill with – or exhibiting mere signs of – cold or flu. Further, that fear of a spinal tap was one reason the parents avoided the hospital.

So far at the trial, none of the prosecution’s doctors has claimed that they could have definitively diagnosed meningitis from the symptoms Ezekiel exhibited at the time. None has claimed that Ezekiel could definitely have been saved, even if he had received aggressive treatment.

Not true at all. They could not speak definitively on a child they had not seen, but it was testified and is knowable what the outcome would have been for a child in the exact same circumstance as Ezekiel if properly treated.

Picazo says the Alberta government shares the blame for Ezekiel’s death because it licences naturopathy.

However, she fails to mention that the ambulance that met the Stephans on their drive to hospital had been stripped of some equipment by that same Alberta government approximately a year before. Consequently, it had no air mask small enough to treat Ezekiel en route to hospital. He spent eight and a half minutes in the ambulance without air. A later CT scan showed brain injury consistent with lack of oxygen.

No, actually. That’s another lie from Selick. The CT confirmed that lack of oxygen was NOT to blame.

A week after Ezekiel’s death, infant air masks re-appeared in ambulances. I can’t help wondering whether the Alberta government is prosecuting these parents to divert attention from its own possible liability.

Gee, that sounds familiar.. 

Quite familiar, in fact. 

Karen Selick is a lawyer and writer based in rural eastern Ontario. During her cold symptoms last week, she did not suspect meningitis and did not rush to the hospital demanding a spinal tap.

Another attempt to confuse cold/flu symptoms with advanced bacterial meningitis.

Also, even if Selick had meningitis and rushed to hospital demanding a spinal tap, only a doctor can decide whether one is warranted. And only a doctor can order one.

Nice narrative, though.

FYI:

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Ugh Canadian health care, amirite?! 

Screen Shot 2016-03-30 at 5.17.28 AMScreen Shot 2016-03-30 at 5.16.37 AM

HERE she is pushing the Shona Holmes lie. And HERE are the facts.)

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( Facts on glyphosate HERE, HERE and HERE )

FTR: This is something the Stephans believe as well. Here’s the mother:

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(Links to THIS )

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Screen Shot 2016-03-30 at 5.22.05 AMScreen Shot 2016-03-30 at 5.13.42 AM

(Links to THIS

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(Links to THIS

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I’ll leave it for you to judge the merits of Selick’s piece, and the wisdom of the Lethbridge Herald in running it.

—-

Update:

On April 14, the Lethbridge Herald ran my response.

The op-ed in its entirety can be found below:

On April 2, the Lethbridge Herald published an incredibly irresponsible and inaccurate op-ed by Karen Selick, a woman who’d taken issue with a column I wrote for the National Post centred around the death of Ezekiel Stephan — a preventable tragedy for which his
parents are currently on trial.

Selick accused me of “factual distortions,” yet failed to specify a single one. Why? Because there were no inaccuracies to identify. All the information in my column was accurate — and verifiably so — unlike the numerous false claims Selick resorted to in the effort to rebut my piece.

For instance, Selick wrote that the nurse-friend who paid the Stephans a visit had counselled against taking Ezekiel to hospital because “he’d probably be turned away from a hospital emergency room.” This is a fabrication by Selick. In fact, the nurse-friend suggested the child might have meningitis and specifically instructed the
parents: “I think you should take him to a doctor.”

Selick also asserted “on the morning of March 13, (Ezekiel) had been in his car seat, perfectly able to bend.” This, too, is not true. According to the parents’ own statements to RCMP — which were played in court — Ezekiel’s body was so stiff from illness that he could not sit in his car seat, which is why he was placed on a mattress (and not a specially-made “crib mattress” as Selick portrayed it as — just a small mattress) in the back of the family vehicle.

Selick then parrots a narrative directly from the father’s own PR offensive — taken either from a conspiracy-laden radio interview or one of many social media updates — alleging that Alberta Health Services was to blame for failing to revive Ezekiel once they were
finally, albeit it far too late, called upon.

“The ambulance that met the Stephans … had been stripped of some equipment by that same Alberta government,” Selick wrote. “Consequently, it had no air mask small enough to treat Ezekiel en route to hospital. He spent eight and a half minutes in the ambulance
without air. A later CT scan showed brain injury consistent with lack of oxygen.”

While it’s true the ambulance lacked a properly-fitting mask for Ezekiel, Selick’s claim of brain-death from lack of oxygen is yet another falsehood. What the CT scan confirmed was that lack of oxygen was not to blame for the child’s death. As medical examiner Dr. Bamidele Adeagbo testified, Ezekiel was brain dead when EMS met up with Stephans. Adeagbo explained what differentiates a brain deprived of oxygen from one suffering meningitis, and concluded there were no signs Ezekiel’s brain died from lack of oxygen.
Ezekiel, he confirmed, was dead before EMS intervened.

Why did Selick feel the need to respond to something I wrote in a publication other than the National Post, the paper which ran my column? I would hope it’s because, like any responsible news outlet, Selick’s submission would be seen as questionable due to the misrepresentations of the case and additional inaccuracies to the ones detailed above.

Readers should also know that Selick is an adherent to, and an affiliate of, the alternative/natural health industry and has appeared at numerous naturopathic/alt-med conferences and events. She is a long-time agitator against the Canadian health-care system, and played a prominent role in pushing the Shona Holmes story and scaring Americans into believing health-care reform was not in their best interest.

Selick seems to believe there’s a government conspiracy to keep treatments and cures from the public so that the pharmaceutical industry can profit off disease, and she is a full-fledged anti-vaxxer who believes vaccines cause autism.

Selick is free to believe what she wishes, of course. But her disregard for evidence, dismissal of science, and embrace of pseudoscience isn’t merely another point of view for a newspaper to print. Nor was her op-ed, as she argued, “another side to the story”
to be presented. Selick’s misrepresentation of the case was a dangerous effort to grant legitimacy to a modern-day snake-oil industry — one in which she has a personal stake.

As I argued in my initial column, people who view the world as Selick does, when reading such nonsense as Selick wrote, are led to believe that there is an alternative to evidence-based medicine.

This, in turn, leads to naturalistic fanatics feeling confident in their deeply-held beliefs that some mythical ‘alternative’ exists to necessary medical intervention should they, or their children, come down with a serious illness — the consequence of which is on display
in a certain Lethbridge courtroom.

More facts about this case and further information on Selick’s connections to the Stephan family and her role in their co-ordinated misinformation campaign can be found  HERE. 

A Most Undignified Death

This column ran in The National Post on January 20, 2016.

The Supreme Court hearing that granted the Liberals a four-month extension to review assisted-dying legislation last week brought out the usual coterie of critics, many of them religious. We are being warned about slippery slopes and disposable lives. Some of the concerns are fair, others essentially boil down to, “My God wouldn’t want you to do this, so it should be illegal.”

One of the more interesting, and credible, reactions, however, from those who would restrict access to euthanasia on moral grounds is that better palliative care is all that’s needed to fully tend to those in the end-stages of life. There is some truth in this — Canada does need a better palliative-care system, for those who’d wish to take that route.

This argument, however, ignores the uncomfortable reality that a sort of medically facilitated death is already well-established in the medical system, but through the cruellest of possible methods. Simply put, our terminally ill are permitted to starve themselves to death.

This isn’t a decision made lightly by any involved — the patient, their family, or the medical professionals tasked with keeping the patient “comfortable” — and it’s an excruciating experience for all. The body can, for a short time, rely on reserves and stores to maintain some basic level of function. In time, though, it begins to consume itself, seeking to convert any usable tissue, including organs, to fuel.

In 2013, I found myself in an unfortunate and frightening medical situation which, by the grace of God, I survived. When I was in hospital, I had a roommate, a woman in her late-70s who, as I fended off sleep for the very real possibility I’d not wake up, sought for herself a very different outcome.

My situation, a gastro-intestinal disease that took hold and spread, making digestion of food impossible, was not terminal. Or, at least, was not meant to be. Her cancer, though, was, and was as at such an advanced state she could no longer handle the daily intubations; the constant poking and prodding and needling; the unrelating physical and mental agony. She was far beyond treatment, and she now had an intestinal obstruction which required surgery to rectify — one which would not add quality to her remaining days, assuming she survived the operation, but would simply allow for the continued oral intake of nutrition.

The alternative was to sustain life through intravenous feeding (TPN). I’d already had that PICC line inserted — a long, specialized IV threaded from the bend in the elbow, up the the arm, and directly into the heart — to deliver basic nutrition.

She was entirely of sound mind and had all other affairs in order, and her family didn’t object when she refused to consent to either the surgery or the central line, asking instead to be allowed to die.

We shared the same highly-skilled surgeon. He was tasked with directing two very different roads of treatment: fighting to keep my body supplied with nutrition while I recovered, and overseeing her demise.

Both our bodies were self-catabolizing. Both were in various states of multi-organ failure — the putrid, potent, unmistakeable stench of renal failure was inescapable and unbearable. For me, the threat of imminent death was terrifying. For her, it was a most merciful gift — an escape from the hell of a body in the final stages of rebellion.

Her suffering was considerable, and I lay in silence, listening as her anguish intensified. Sometimes what I heard carried over into dreams. When asleep, I heard the very real sound of nurses struggling to place a tube in her esophagus, played out in my own shallow nightmare in which I was choking on my own and failing to breathe.

After a series of conversations between my roommate, our surgeon, and her family, she was moved to a private, under-no-circumstances-to-be-disturbed room directly across from the one we’d shared, where she’d quietly deteriorate and rapidly emaciate. Her son held vigil, stoic, at first, and then less so.

The end was neither merciful, painless, nor swift. It took weeks for her to die. Her pain eventually came to an end, but her son’s never will. Had euthanasia been available, as she wished it was, it would have spared my roommate the drawn-out ravaging, and her son the unnecessary, additional trauma. The end result, of course, would have been identical.

It’s not clear to me where the ultimate line should be drawn in terms of age or disease, or what would constitute sufficient level of suffering — or how the extent of which would be measured. These issues are, to state the obvious, complicated. But as the government works to draft new assisted-suicide legislation, it’s essential people be aware of what is currently the status-quo, and why it cannot be allowed to stand. We’ve had a form of medically facilitated death in Canada for years. It is far crueller, but no less fatal, than a quick, merciful needle.

 

Ending The Stigma

This op-ed appeared in the Ottawa Citizen on January 28, 2014.

 

On Dec. 29, Christopher Peloso, the 40-year-old husband of former Ontario deputy premier George Smitherman, was reported missing.

“Freedom from depression has been elusive for Christopher,” Smitherman tweeted on the eve of the 29th. “We fear for his safety.”

A followup tweet issued just hours later linked to a brief statement which confirmed that Peloso had been found dead, noting (the family) would “find comfort somehow in knowing that he has found peace from the depression that has wreaked havoc on his mind.”

At Peloso’s memorial, Smitherman eulogized his late husband, telling those assembled in the Toronto community centre he would “not be afraid, in Christopher’s name, to tell his story and to tell our story … A man took his life because the pain in his brain was unrelenting.”

Smitherman addressed those who might be dealing with depression: “If you’re holding something back and you bring it out into public life, it is the first step and it is cathartic and it is powerful.”

To that end, Peloso’s father, Reno, spoke of his son, noting “Chris suffered from depression and committed suicide and there is no shame in that.”

Not only was this a powerful message to send during a period of such personal grief, but it was a remarkable, and incredibly necessary, break from the norm; of glossing over the heart of the tragic situation; of speaking in euphemisms and dancing around the issue that caused so much pain, such unrelenting anguish, that the only reprieve Peloso thought he could find was through death.

Though Peloso’s loved ones were widely lauded for their openness in discussing his lifelong battle with depression, the notion that suicide be addressed so matter-of-factly proved disquieting for many. Some feared that accepting Peloso’s final act without judgment somehow glorified it, that failing to attach shame or scorn to the suicide essentially validated, or worse, encouraged it.

These widely held, though unfounded, concerns demonstrate why it was necessary for Peloso’s family to address his illness — including its end — so candidly: to break the stigma about what it is to live with, or die from, mental illness, so that others might find the courage to seek help for their own demons, or, for those who have lost love ones in a similar manner, to leave behind the guilt or sense of having failed the deceased.

And breaking the silence, erasing the stigma, is what Bell’s Let’s Talk campaign on Jan. 28 is all about.

One in five Canadians will experience some form of mental illness in a given year. Yet a report from the Canadian Medical Association revealed that only half of Canadians would tell a friend if they had a family member with a mental illness, as compared to disclosing a family member’s diagnosis of cancer (72 per cent) or diabetes (68 per cent). But why is that? Like any ailment, mental illness manifests in a number of ways, and to varying degrees of severity. Not every cancer is treatable; broken bones don’t always heal correctly the first time. Some diabetics are able to manage through diet alone, while others require multiple shots of insulin, daily. That lack of understanding of what constitutes mental illness, especially when it presents as a chronic or severe condition, is what drives the stigma surrounding it. And the apprehension about openly discussing the more extreme cases of mental illness — those who self-harm, commit suicide, are plagued by intrusive, sometimes violent thoughts, are crippled by rituals or compulsions — only furthers the ignorance surrounding such conditions.

The same CMA report found nearly a third of Canadians reported being fearful of being around someone suffering from a mental illness; almost half believing people use the illness as an excuse for bad behaviour, and fewer than half reporting a desire or willingness to associate with a friend who was diagnosed with a mental illness.

How terribly sad. It should be noted, however, that such beliefs aren’t because people want to exclude or isolate those suffering from a mental illness. Only recently have people begun to buck the societal norm of only speaking of mental illness in whispers, of “othering” those who suffer. In many cases, people want to better understand; they are genuinely interested in learning more about what it means to live with a mental illness, about the challenges faced not only by those diagnosed, but how their experiences, in turn, affect the lives of those around them.

The problem is, they are unsure of what, or how, to ask.

They don’t want to intrude, are afraid of offending. So they instead make assumptions, quietly draw their own conclusions.

Which then leads to misconceptions, feeds into the fear, and further perpetuates the stigma. This is why Bell’s Lets Talk campaign is so important: It provides a platform for a genuine conversation between those living with mental illness and those who’ve never experienced it. Those afraid to ask questions can follow as people share their stories of living with the disease, silently gaining a better understanding of what it means to have a mental illness. Many who suffer in silence find strength in seeing others talk openly about their own struggles and, in turn, find the courage to open up, and if they haven’t already, seek help.

The family of Christopher Peloso understood the value in having a candid dialogue about the illness that plagued him, and ultimately claimed his life. They were, in essence, doing exactly what the Let’s Talk campaign aims to accomplish on a larger scale: To end the stigma surrounding mental illness, talk openly and honestly about all aspects of the disease, foster a better understanding about life with mental illness, and to encourage those who are suffering to reach out.

There is no shame in having a mental illness, and there’s no weakness in seeking help.

And there’s no better time than now to talk about it. So Let’s Talk, Canada.