Thursday, November 14, 2013

Against the use of non-certified health 'remedies' in resource poor countries

My Editorial from the December issues of Developing World Bioethics.
Homeopathy organisations have taken to the skies to help sick people in resource poor countries as well as disaster zones. The thing about homeopathy is, of course, that there is zero evidence that homeopathic concoctions have any effect beyond that of other placebos.[1]Governments such as the UK's have clamped down on the quack therapy degrees that flourished for a good number of years in parts of its university sector. In 2007 a whopping 5 BSc degrees in homeopathy were offered; today there is none.[2]
While one could appreciate these homeopaths' good intentions, it is deeply unsettling that people without proper medical training use donations provided by their supporters to travel to developing countries and essentially apply their unproven concoctions on sick and dying people. During Haiti's recent cholera epidemic, on their own account they provided ‘remedies’ to cholera patients.[3] The term ‘remedy’ is probably carefully chosen by these people who show up in impoverished Haitian communities in medical-doctor-like white coats,[4] clearly giving the impression to the undereducated local populace that they are health care professionals. This masks to the uninitiated observer as well as to the local patients that their remedies are precisely that, concoctions that have no proven medicinal value. They are not medicines. The homeopathic emperor really is naked. I didn't say it first, but it is still true.
David Shaw, writing in the British Medical Journal, reports that training’ programs have been set up that ‘train’ locals in homeopathy. He writes, ‘the creation of homeopathic pharmacies increases the likelihood that Haitians will not obtain effective treatments for future illnesses. Training 38 people as homeopaths simply compounds the unethical effects of Homeopaths Without Borders' presence in Haiti, as does the attempt at legitimisation represented by their attempt to obtain official licences.’[5]
A different example: other activists reportedly traveled from the USA to virulently anti-gay Jamaica to ‘heal’ gay Jamaicans and turn them into heterosexuals.[6] Vulnerable Jamaicans were subjected to treatments that are known not to work. What is by now illegal in many jurisdictions, namely offering and providing treatments for homosexuality, is now exported to resource-poor countries. Damage is predictably done to the psychological well-being of perfectly healthy gay Jamaicans.
It appears to be the case that the developing world has become a playground for the vaguely health-related activities of activists that have been thoroughly discredited in the wealthier and better educated parts of the world. These are shocking developments.
It is an interesting question how one should approach an ethical critique of these sorts of activities, namely of well-heeled Westerners abusing their privileged situation to inflict at best unproven medical concoctions and treatments on vulnerable populations in resource poor countries. If they were professionals (say in the Jamaican case if they were psychologists or psychiatrists, or in the Haitian case medical doctors or nurses) one could report them to their professional regulatory bodies. Unfortunately, these people are not professionals, hence appeals to ethical professionalism or professional bodies fail. Appeals to common sense are also likely to fail, because who other than a fanatic would want to travel to other countries to spread the word about concoctions that they know are not taken seriously by specialist professionals in their home countries?
Ethically, all that's left to say for the Haitian situation is that it is harmful to use such unproven concoctions and therapies on patients seeking help. It is also unacceptable to present oneself as a health care professional when one is not. For actual health care professionals providing homeopathic concoctions, the charge would be that they are acting unprofessionally by not providing standard, proven medical care. Cholera cannot be addressed with unproven homeopathic remedies. People will inevitably get hurt. For the Jamaican case, the harm to perfectly healthy people is again what is at issue. It will be distressing to these people both to undergo whatever ‘therapy’ is visited upon them, and it should be just as distressing to note that they failed, given the prevalent anti-gay sentiments in the country.
Harm is also done to impoverished communities by the fundraising activities of these organisations. Gullible donors will waste valuable financial resources that could go to actual sensible health care or development goals and that will instead be diverted toward the establishment and dissemination of quack therapies and treatments in resource poor environments.
To my mind governments in the West should police these activities in the same manner that they police the activities of sex tourists who travel to resource poor countries to exploit children. Equally, governments in Haiti, Jamaica and elsewhere should not permit their most vulnerable citizens to be abused by representatives of such organizations.

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