A one-time school project gone terribly, terribly wrong.

19 September 2008

Does Health Canada Have a Sense of Humour?

I've been wanting to read up on Bill C-51 for some time. It's probably the only Harperite legislation I've liked. Basically it regulates the "Natural Health Product" (NHP) field; which is so described because chewing willow bark is presumably much more natural than taking an Aspirin made from the same willow bark, I guess.

There's been some reaction, including street protests in Hometown--which is ridiculous. Except that as a semi-hippie-ish community we have plenty of practicioners of woo* here. Rumours are rife that C-51 will require you to get a permit to give your kids vitamin tablets, ban chiropractors, and cause a variety of other unpleasantnesses. Including, critically, the idea that such treatments will fall from the "approved" list on our single-payer health care system, and from various private plans.

I tend to sneer at alternative and complimentary medicine. But I also don't deny that what makes us feel good makes us feel good. I visit a chiropractor myself, when my back hurts, and I feel there's some benefit. So if they're going to force me to pay full freight for my own bonecracker appointments, I figured I'd like to find out what the Bill is actually proposing.

First, I should point out that the stated reason for the new regs seems specious to me. The site waffles on about the poisonous toothpaste business (where South African tubes labelled "Colgate" and "Made in China" made it onto shelves). But really I think the two central points were to enable the responsible ministry actually to enforce consumer product recalls instead of just issuing warnings, and to regulate the increasing flood of NHPs

Basically, it comes down to two things. C-51 would:
1) Make sure NHPs had a list of ingredients on the label, and conversely, enforce a rule that what's on the label is in fact what's in the bottle.

2) Make sure that claims of efficacy were scientifically backed.

In other word, it would essentially hold NHPs to a standard of proof roughly comparable to that required to sell anything else to the public, from furniture to forks. Which only makes sense. After all, would you go for laetrile therapy, knowing that's it's not just garbage but actually harmful? Yet there are places where it's still touted as a cancer cure, in the face of the actual science on the issue.

Nothing about the bone benders, either. So it's pretty much all good.

However, the humourous note comes on the FAQ page here. Scroll down and read the last FAQ.

(*Woo is a term borrowed from Orac over at Respectful Insolence. It refers to bunco cures and other fraudulent "health" paraphenalia)


At 4:49 p.m., Anonymous Anonymous said...

Love that last FAQ. I wonder who asked it? Do you think Bill C-51 will effect my ability to purchase cotton/poly blend tube socks?


At 7:48 a.m., Blogger Ex-drone said...

I applaud your skepticism, but I would like to offer a few clarifications. Many people think that Bill C-51 is intended to regulate NHPs, but this is not really true. NHPs were regulated in 2004 when the NHP Regulations came into force. These regulations will remain in force after Bill C-51 is passed, and Bill C-51 does not change them.

What Bill C-51 does is amend the Food and Drugs Act to enhance the enforcement measures for Health Canada. For example, it raises maximum fines from $5K to $5M and addresses legal loopholes, like allowing inspectors to pass through private property to inspect facilities subject to site licensing.

The strategy for regulating NHPs was established in 1998 in the Standing Committee on Health's report NHPs: A New Vision and has been followed fairly consistently by subsequent Liberal and Conservative governments. It came about after lobbying from the NHP industry as a means of legitimizing their products and getting the government to regulate their safety and quality. It is ironic that part of that industry is now complaining about those regulations. However, the StopC51 mob have a backstory about a supplement company that had a legal run-in with Health Canada and are now reaping their revenge to get NHPs deregulated. At Ottawa Skeptics, we have been waging a campaign against StopC51 outrageous claims and propaganda.

Bill C-51 and, in fact, the Food and Drugs Act do not address chiropractic treatment. Instead, they are concerned with food, NHPs, drugs, cosmetics and medical devices. For NHPs, the NHP Regulations do regulate the safety, quality and effectiveness of NHPs. I agree with your comments in this area, but you will probably be disappointed to hear that the regulations do not mandate that health claims (i.e., effectiveness) for these products must be demonstrated scientifically. Manufacturers can make scientifically-based health claims, but sadly, they can also make "traditional use" claims for product licensing.

To make a "traditional use" health claim, the manufacturer just has to show evidence that an NHP ingredient has been used within a traditional cultural medicine system (e.g., Ayurvedic, traditional Chinese or aboriginal medicine), such as by reference to an accepted pharmacopeia. The subtle difference is that, instead of the health claim saying, "Used to relieve headaches", which must be scientifically demonstrated, the claim says something like "Traditionally used in Ayurveda to relieve headaches". The problem with this approach is that it legitimizes known placebos and quack medicine, such as homeopathy. To see examples of these health claim, you can check out Health Canada's Compendium of Monographs, which is a collection of approved health claims for NHP ingredients. If you want to see how silly they get, read the ones for Astragalus.

Nevertheless, we are four years down the road of legitimizing "traditional use" health claims, so it's probably not worth fighting. Enhanced regulation of NHPs with at least a low standard of evidence is better than no regulations on health claims at all. The US have allowed themselves to fall into that rut under Dietary Supplement Health and Education Act (DSHEA). Down there, NHP manufacturers can make almost any health claim as long as they include the disclaimer that "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease."

Barry Green
Ottawa Skeptics

At 8:30 a.m., Anonymous PJ said...

Barry, thank you for that clarification. I was Googling heavily trying to find all sides of the story.

At 8:18 a.m., Blogger Metro said...

Only if the Tories win a majority, in which case they'll probably throw that in--They're known to be big on Leviticus.


Thanks for that clarification. I'm okay with that, really.

"Used in traditional medicine to ..." seems to me to be as red-flaggy as the proper label: "Used by primitive superstitious cultures who didn't have the benefits of science to substitute for ..."

It also seems to me that such a requirement means no-one can come up with new woo. For example, saying that it's been discovered dolphin's wool can cure cancer or some such thing.

Of course I suppose they could then claim it had been "Used in Ancient Atlantean medicine ..."

One wonders if a product that "Has not been verified by the FDA" could be un-verified by the FDA and chucked from the shelves.

Thanks for the explanation.


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