At a drug store in Centretown, pills and supplements crowd both sides of an aisle. On one side are pharmaceutical drugs. On the other side are natural health products – alternative medicines and supplements derived from natural sources. This category includes vitamins and mineral supplements, herbal medicines and homeopathic remedies. Both categories are regulated by Health Canada.
But while pharmaceutical drugs are subject to intense scrutiny and required to present scientific evidence from clinical trials, natural health product regulation is lax. That distinction undermines the credibility of our regulatory system and puts Canadians at risk.
According to Statistics Canada, Canadians spend about $2.5 billion annually on natural health products. These products purport to ease arthritis pain, cure insomnia and even help children learn. But do they?
In 2004, Health Canada’s Natural Health Products Directorate (NHPD) began regulating natural health products. Although the move did bring some order to a lawless field, the effect has been to give a government-approved stamp of credibility to claims supported by little or no evidence.
In 2008, the government attempted reforms to ensure “tainted products are found and recalled, that what is on the label is actually in the bottle, and that health claims are supported by evidence,” Health Canada spokesman Paul Duchesne said at the time. The bill died when an election was called.
On their website, the NHPD claims they “ensure that Canadians have ready access to natural health products that are safe, effective and of high quality.” However, when assessing claims of safety and efficacy, the NHPD allows applicants to present evidence based only on “traditional use.” If the product has been in use for 50 years or more, the NHPD simply assumes it is effective and allows the manufacturer to make a health claim.
Claims backed by traditional evidence must be qualified with “traditionally used to…” or a similar message. But the government certification still has the effect of reinforcing the credibility of a claim not backed by real evidence.
For example, echinacea is commonly used to prevent colds, but numerous clinical trials, including one published in 2005 in the New England Journal of Medicine, have found it to be ineffective.
Natural health advocates often argue that evidence of long use is enough to prove effectiveness. But there are enough cases of past medical mistakes – bloodletting, leeches – to show that traditional evidence should have no place in our regulatory system.
Modern medicine bases its power, safety and credibility on science, both as a body of knowledge and as a tool of inquiry. The scientific method requires that claims be supported by evidence gathered in rigorous trials and experiments. While scientific knowledge is sometimes proven wrong, this doesn’t happen through rejecting the scientific method but rather through embracing it. Extraordinary claims are submitted to extraordinary scrutiny. Only when the evidence is weighty enough do the scales tip and new ideas gain widespread acceptance.
Instead of relying on traditional or anecdotal evidence, modern medicine’s gold standard is the double-blind, placebo-controlled clinical trial.
By using large numbers, control groups and careful monitoring, scientists can control for selection bias, placebo effect and coincidence. Even then, a single trial or study rarely changes medical practice. Instead, the sum of many studies and trials shapes treatment. This protects patients from unsafe and ineffective treatments. Natural health products don’t have that kind of protection.
“Natural is safer” is a widespread fallacy. Yet Health Canada’s own documents admit that side effects from natural health products can be just as serious as those for pharmaceutical drugs. If they are, why aren’t they being regulated like drugs? No level of risk is acceptable if the benefits aren’t proven.
The dubious claims made for these products can discourage people from seeking conventional medical treatment. A government stamp of credibility is an endorsement of not only the product, but also of branches of medicine that ignore and often reject science – with potentially dangerous consequences.
In a recent CBC Marketplace investigation of homeopathy, the host interviewed a woman who had chosen not to give her child conventional vaccines. Instead, she had given the child homeopathic vaccines, which aren’t accepted by the medical and scientific community. Let’s hope this child isn’t exposed to polio.
Although the NHPD doesn’t allow any homeopathic products to claim to be vaccines, government approval of other homeopathic remedies lends credibility to the entire belief system.
If natural health products are effective, their manufacturers should have no problem presenting scientific proof. Otherwise, they should not be permitted to make health claims of any kind.
Our regulatory system exists because Canadians do not have the time or the resources to assess each and every product for safety and efficacy.
This system works best when decisions are made on the basis of the best evidence. When it comes to medicine, the best evidence is scientific.
Rather than allowing “traditional use” claims, the onus should be on manufacturers of natural health products to present scientific evidence from clinical trials or other relevant scientific studies to show their products are safe and effective.
The products that pass can stay on the market and keep their health claims. The ones that can’t should be placed with bloodletting and snake oil – on the magic shelf.