Homeopathy in UK Pharmacies: PR Disaster

Look at the headlines:

Boots: Homeopathic Remedies Please Customers Rather Than Cure

Distrust me, I’m a Pharmacist (registration required):

So why are so many nonsensical products available from Boots, our trusted family chemist? Has Boots become UK’s largest purveyor of placebos? Are pharmacists shopkeepers, only out to make a profit, or healthcare professionals keen to improve public health?

The NHS should not waste our cash on homeopathy:

Placebos, including homeopathy, don’t work as well as the therapies that have been tested against them and been found to be significantly more effective. The NHS has a fixed budget each year: if £4 million is spent on homeopathy, it means that £4 million is not available for more clinically effective treatments.

And check out this open letter to Boots from Merseyside Skeptics.

The Boots brand is synonymous with health care in the United Kingdom. Your website speaks proudly about your role as a health care provider and your commitment to deliver exceptional patient care. For many people, you are their first resource for medical advice; and their chosen dispensary for prescription and non-prescription medicines. The British public trusts Boots.

However, in evidence given recently to the Commons Science and Technology Committee, you admitted that you do not believe homeopathy to be efficacious. Despite this, homeopathic products are offered for sale in Boots pharmacies – many of them bearing the trusted Boots brand.

Not only is this two-hundred-year-old pseudo-therapy implausible, it is scientifically absurd. The purported mechanisms of action fly in the face of our understanding of chemistry, physics, pharmacology and physiology. As you are aware, the best and most rigorous scientific research concludes that homeopathy offers no therapeutic effect beyond placebo, but you continue to sell these products regardless because “customers believe they work”. Is this the standard you set for yourselves?

The majority of people do not have the time or inclination to check whether the scientific literature supports the claims of efficacy made by products such as homeopathy. We trust brands such as Boots to check the facts for us, to provide sound medical advice that is in our interest and supply only those products with a demonstrable medical benefit.

We don’t expect to find products on the shelf at our local pharmacy which do not work.

Not only are these products ineffective, they can also be dangerous. Patients may delay seeking proper medical assistance because they believe homeopathy can treat their condition. Until recently, the Boots website even went so far as to tell patients that “after taking a homeopathic medicine your symptoms may become slightly worse,” and that this is “a sign that the body’s natural energies have started to counteract the illness”. Advice such as this directly encourages patients to wait before seeking real medical attention, even when their condition deteriorates.

We call upon Boots to withdraw all homeopathic products from your shelves. You should not be involved in the sale of ineffective products, because your customers trust you to do what is right for their health. Surely you agree that your commitment to excellent patient care is better served by supplying only those products whose claims can be substantiated by rigorous scientific research? Or do you really believe that Boots should be in the business of selling placebos to the sick and the injured?

The support lent by Boots to this quack therapy contributes directly to its acceptance as a valid medical treatment by the British public, acceptance it does not warrant and support it does not deserve. Please do the right thing, and remove this bogus therapy from your shelves.

I would not be surprised to see pharmacists bumped off the top of the “Most Trusted” professional list, as a result of press like this.

Are pharmacists going to take responsibility for their own profession, advocate for science-based pharmacy, and stop selling homeopathy? Or will we be complacent, until we’re called out for allowing placebos to sit on pharmacy shelves?

 

 

Recommended Skeptical References

I’m a voracious reader, and I thought I’d share some of my favorite books over the past year that have challenged, inspired, or enriched me. Whether you’re a health professional or not, I strongly recommend you put these on your reading list. They’ve helped me a lot in refining my philosophy about pharmacy practice, and improving my skeptical viewpoint.

The Demon-Haunted World – Science as a Candle in the Dark – If you read only one book on this list, make it this one.  It is Carl Sagan’s challenge to us to fight pseudoscience. The book describes the scientific method as an awe-inspiring method of discovery.  It will encourage a skeptical and critical mindset, and challenge you to think carefully about your own assumptions. Some of the book is spent discussing logical fallacies, which has helped me improve my criticism skills.

On Being Certain This is a great book that deals the feeling of certainty that we have about things. Written by a neurologist, the book makes a convincing argument that “certainty” is a mental sensation, and not evidence of fact. In fact, Burton argues that it’s actually independent of active reasoning. Certainty, he concludes, is actually not biologically possible. We must use science as a method to evaluate data according to its likelihood of being correct.  An enjoyable and challenging read. Here’s a review at Science-Based Medicine.

Snake Oil Science This book does a fantastic job of explaining the rise of alternative medicine, as well as how health professionals are challenged to avoid making logical inferences. But the finest section of the book deals with the placebo effect – it’s the best explanation I’ve ever read. The book concludes with a dissection of systematic review of alt-med, and illustrates what high-quality systematic reviews really say about various complementary and alternative practices. Highly recommended. Here’s a review at Science-Based Medicine.

Autism’s False Prophets Until dealing with H1N1 this year, I had no idea about the level of antivaccination sentiment in Canada. And the “manufactroversy” about vaccines and autism baffled me.  I watched Orac battle the antivaxxers almost daily, but didn’t have a good sense of how this irrational and dangerous cult became established. For a succinct summary of how different organization and individuals have mislead the autism community, and established the modern antivaccination movement,  this book is a fantastic resource. Having read this book, you’ll understand the history of the antivax movement, and have a better understanding of their tactics. I believe it should be mandatory reading for every pharmacist. I also highly recommend you also read Amy Wallace’s recent article in Wired magazine, where Offit is profiled in the article “An Epidemic of Fear”.

Fooled by Randomness This book, by Nassim Nicholas Taleb, deals with luck and chance: How we understand it, and how it shapes our decision-making. Taleb, a mathematical trader “obsessed with uncertainty”, is a natural skeptic. The book focuses on different type of what he calls “thinking deficits” and makes a persuasive case for how we favour the visible and the personal, and minimize or ignore the abstract. It’s why one anecdote can convince someone of the value of an intervention ( like “homeopathy worked for me“) despite persuasive evidence that it’s placebo.

Trick or Treatment -Written by Edzard Ernst, a professor of complementary medicine, and Simon Singh, an author and science journalist now infamous for being sued by the British Chiropractic Association, this book doesn’t pull any punches. “The Undeniable Facts About Alternative Medicine” is the subtitle. It’s a fantastic read. The book opens with a review of the scientific method with some interesting historical facts. The book then dedicates a chapter each to acupuncture, homeopathy, chiropractic, and herbal medicine. The book concludes with a discussion of placebo therapies and their place in patient care. The appendix includes one-page summaries of dozens of alternative health modalities, with a short summary of their effectiveness. Highly recommended for everyone. Here’s another review from Science-Based Medicine.

How We Know What Isn’t So Why do people believe in the absurd, like homeopathy, despite all evidence? This book will help answer that question. Another good overview of critical thinking, this book outlines how human reason is fallible, and what to do about it.  While the books is over 15 years old, it’s still completely relevant. This book will likely force you to consider your own thought processes and beliefs -it did for me.

Why People Believe Weird Things – This book by skeptic Michael Shermer, looks at alien abduction, Creationism, psychics, recovered memories, Holocaust, and more. He explores why even well-educated people can hold beliefs that seem utterly baffling to others.

 

 

Those are my recommendations for anyone interested in pseudoscience, skepticism, and critical thinking. If you have any related books you’d recommend as a must-read, please list them in the comments. I’m compiling my “to read” list for 2010.

Homeopathy in Pharmacies: Scrutiny in the UK

It looks terrible on pharmacists and pharmacy practice: Homeopathy, on pharmacy shelves.  In front of Members of Parliament, the  Professional Standards Director for Boots, a huge British pharmacy chain, made the following admission last week:

There is certainly a consumer demand for these products. I have no evidence to suggest they are efficacious. It is about consumer choice for us and a large number of our customers believe they are efficacious.

Ugh. Profits before ethical patient care. Foreshadowing for Canadian pharmacies?

In the United Kingdom, the parliamentary science and technology met last week to evaluate the strength of evidence that supports the MHRA’s decision (their version of Health Canada) to license homeopathic products for sale, and allow claims to be attached to these products without evidence that they work. Pointed questions were directed at Boots and their decision to sell homeopathy in pharmacies.

The hearing are well worth reading through.  And the media response has been scathing. “However they sugar it, you’re swallowing a delusion” says The Times:

Boots sees no reason to stop selling a line of products of no proven value when there are still consumers (gullible mugs) prepared to buy it.

Ben Goldacre both spoke at the hearings, and then wrote about it later, in an article entitled Homeopathy and the nocebo effect:

There were comedy highlights, as you might expect from any serious inquiry into an industry where sugar pills have healing powers conferred upon them by being shaken with one drop of the ingredient which has been diluted so extremely that it equates to one molecule of the substance in a sphere of water whose diameter is roughly the distance from the Earth to the sun.

The man from Boots said he had no evidence that homeopathy pills worked, but he sold them because people wanted to buy them. The man from the pill manufacturers’ association said negative trials about homeopathy were often small, with an average of 65 people, and “all statisticians” agreed you need 500 people for a proper trial. Not only is it untrue that you necessarily need this many people ; he then cited, in his favour, a positive homeopathy trial with just 25 patients in it.

The Telegraph also weighed in,  with an article entitled: Boots: We sell homeopathic remedies because they sell, not because they work.

With homeopathy creeping into many Canadian pharmacies, as well as pharmacy continuing education programs, that headline may yet appear in Canada. Stay tuned.

It’s been quite a week

This has been a week like no other for this tiny little blog. The doors opened here almost a year ago, with the stated goal of driving improvements in pharmacy practice, by scrutinizing its practices. Naturopathy wasn’t on the agenda. I have encountered naturopaths throughout my career. Nice and well meaning, all of them. But I was baffled by their recommendations and treatment suggestions, as they appeared completely detached from science and evidence.  I admit to a “What’s the Harm?” mentality, until it appeared that the Ontario government was about to give naturopaths prescribing privileges. I blogged about it during 2009, focusing on the implications of the extension of prescribing rights to a group that does not practice in a science- and evidence-based way.

As part of my Skeptic North blog contribution, I compiled a summary of my prior posts about naturopath prescribing into the article Magician Prescriptions.  It received several hundred hits, some letters of support and a nice plug from Phil Plait, the Bad Astronomer.

Things changed – a lot – on Tuesday. The National Post, which has been reposting some of the Skeptic North articles on their own site, asked to adapt my article and publish it, both in print and online. It appeared in Tuesday’s paper, blown up to a full page, with a big picture, and the new title Naturopathy a Prescription for Quackery (their title, not mine). I expected a reaction, but was totally unprepared for the level of vitriol I received, including personal and professional slurs (some appear in the comments to the National Post article), thinly veiled threats, and even being likened to the Nazis. In general, comments were personal or ad hominem attacks, with lots of special pleading and hand waving, and no effort to refute the key points of my argument. Given so many trotted out the “Big Pharma Shill” argument, I started to wonder if it was a statement of envy, rather than anger…after all, naturopaths are asking to prescribe those evil prescription drugs!

The Ontario Association of Naturopathic Doctors responded on Thursday, with a letter to the editor entitled, No ‘Magic’ Involved In Naturopathic Medicine. More handwaving and special pleading. The cognitive dissonance was remarkable, given the claims of “it’s science!” with one author selling detoxification services and the other offering colon hydrotherapy.

The comment thread below the naturopath’s rebuttal is something to behold, and I recommend that everyone read it, as it neatly rebuts  the arguments put forward by the naturopaths – and more.

Since the bill was was revised, it is now receiving international scrutiny: White Coat Underground, Terra Sigillata (two posts!), Science-Based Medicine, Greg Laden’s Blog, and others have weighed in.

Finally, it seems I even offended a magician this week, as one commenter admonished me:

“Please don’t call these charlatans, “magicians” or their quackery, “magic”. I practice the ancient and honorable craft of magic. I deceive, with others’ permission, to entertain, not to make a buck off of sick people that should see a real doctor.”

Sigh. It really has been quite a week. I wonder what next week will bring?

UPDATED  November 30: Two more posts on the topic, from Dr. Steven Novella at Skepticblog and Dr. David Gorski at Science-Based Medicine.

UPDATED December 2: The Bill has passed: This and prior posts have been edited and/or removed for time-relevant content.

The Physics of Homeopathy Explained: Part Two

How does homeopathy work?  It uses the dilithium matrix to stabilize the warp pressure enough to maintain the inertia necessary to gather deuterium particles with the brassard collectors. Oh wait, that’s Star Trek.

 

 

 

 

 

 

 

But via the hilarious site Homeopathy World Community comes this gem, which isn’t much different. Sit back and enjoy.

Homeopaths are still struggling to explain how water can have medicinal effects.  Rather than admitting that these treatments are profoundly unscientific, and don’t actually work, they string together meaningless technobabble to make homeopathy sound scientific. But it’s a belief system – nothing more.  And these tortured explanations are increasingly resembling self-parody.

 

 

Your Urine is Not a Window to Your Body: pH Balancing – A Failed Hypothesis

One of my first encounters with “alternative” health was the “pH balance” idea. A customer approached me at the pharmacy counter and asked for “pH test strips.” I asked him about kidney stones, diabetes – the usual reasons you test your urine. He told me he was healthy, and he was just monitoring his body’s “acid balance” and that he kept his body “alkali” to be healthy.  “You can’t change your body’s pH, sir – if your pH changes, you’ll die,” I explained, in my most reassuring pharmacist voice. “You don’t know what you’re talking about,” he snapped at me, “I adjust my pH all the time.” I handed over the urine testing strips, rang it into the cash register, and wondered, what is this guy talking about? Where did he get the idea he could manipulate his body’s acidity?

Should We Maintain an Open Mind about Homeopathy?

No.

It is considered unethical for modern medical practitioners to sink to this kind of deception that denies the patient his or her autonomy. Secondly, by opening the door to irrational medicine alongside evidence-based medicine, we are poisoning the minds of the public. Finally, if we don’t put a brake on the increasing self-confidence of the homeopathic establishment, they will cease to limit their attention to self-limiting or nonspecific maladies.

More, from Michael Baum and Edzard Ernst, writing in this month’s American Journal of Medicine, here.

 

The Physics of Homeopathy – Finally Explained!

This has to be seen to be believed. It’s the physics of homeopathy – as explained by a an optometrist who dabbles in homeopathy.  Watch it – but I take no responsibility for the brain cells that will rupture upon viewing.

We discovered a few days ago that even the light reflecting off Saturn can made into a remedy.  When groups lilke naturopaths claim that homeopathy is science, what does this say about their ability to provide reality-based health care? And why do  pharmacists continue to enable this antiquated practice by selling homeopathic products in pharmacies?

Go read the Science-Based Medicine post for a dissection of the “science” in this presentation.

Autism Quackfest Hits the Media

It was bound to happen. And I’m glad to have done my part. I’ve been blogging since August about the questionable judgment of the SickKids Foundation for their support of rank pseudoscience at the upcoming AutismOne Conference, Changing the Course of Autism.

It’s now a national story in Canada. Tom Blackmore, of the National Post, weighs in today: Controversial autism conference got funds from Sick Kids

A branch of Toronto’s renowned Hospital for Sick Children is being criticized for funding an autism conference whose organizers champion the discredited belief that childhood immunization causes the neurological disorder.

The event – to start on Saturday at the University of Toronto medical sciences building – also includes presentations that some experts are calling unproven science, promoting such alternative treatments for autism as homeopathy and hyperbaric oxygen chambers.

Organized by the American group AutismOne and Austism Canada, the meeting has received $5,000 in funding from SickKids Foundation, the hospital’s fundraising wing.

Blogs designed to expose practitioners of dubious science have railed against the event for the past two months, questioning why a respected health-care institution would offer its support to a group that considers vaccination of children a health risk.

“The name of Sick Kids is worth more to them than the money: it is a stamp of legitimacy”

“Sick Kids hospital has some of the world’s most renowned autism researchers. I suspect most of them would not be thrilled by the fact that SickKids Foundation is supporting this conference.”

The full story is here.

As I blogged about this last week over at the Skeptic North blog, with content this dubious,  you’d expect science-based organizations to stay far, far away. Sadly, the SickKids Foundation, with their “neutral stance” towards pseudoscience, is a confirmed sponsor. And now they’re facing well-deserved scrutiny.

The Post also has a nice piece on the role that bloggers played: Blogs raise the alarm on autism conference. Skeptic North, Respectful Insolence, and Sandwalk are all mentioned. Science-Based Pharmacy isn’t mentioned…but that’s OK. I’m happy to see some well-deserved publicity for Skeptic North and its team of writers.  (The Post says I run the Skeptic North blog – that’s incorrect. To be clear, Steve Thoms is Skeptic North’s editor).

I’m pleased to see the media questioning the propagation and sponsorship of pseudoscience. As I blogged about earlier this week, the antivaccination rhetoric is peaking, with the arrival of the H1N1 vaccine. Why the SickKids Foundation would support anti-vaccination organizations, that will only lead to more sick kids, continues to escape me.

Homeopathy Harnesses the Power of Saturn

As I’ve blogged before, homeopathy is a pre-scientific practice without any basis in reality. Nevertheless it continues to be embraced by non-scientific practitioners like naturopaths and homeopaths.

One of the underlying principles of homeopathy is the “proving”. The proving is the process by which a homeopathic remedy’s “profile” is evaluated.  The proving determines which remedy will be appropriate for which symptoms.

From Wikipedia:

At first Hahnemann used material doses for provings, but he later advocated proving with remedies at a 30C dilution, and most modern provings are carried out using ultradilute remedies in which it is highly unlikely that any of the original molecules remain. During the proving process, Hahnemann administered remedies to healthy volunteers, and the resulting symptoms were compiled by observers into a “Drug Picture”. The volunteers were observed for months at a time and made to keep extensive journals detailing all of their symptoms at specific times throughout the day. They were forbidden from consuming coffee, tea, spices, or wine for the duration of the experiment; playing chess was also prohibited because Hahnemann considered it to be “too exciting”, though they were allowed to drink beer and encouraged to exercise in moderation. After the experiments were over, Hahnemann made the volunteers take an oath swearing that what they reported in their journals was the truth, at which time he would interrogate them extensively concerning their symptoms.

Proving is part of the homeopath’s curriculum. For example, the Canadian College of Naturopathic Medicine offers lectures on proving methodology.

So what substances can be proved? Pretty much anything can be a homeopathic remedy. Raccoon fur is one example.  Even the light reflecting off Saturn can be “proven”. As described in this month’s International Homeopathic Internet Journal:

The remedy was made by exposing powdered milk sugar to a powerful telescope in Boston, Massachusetts while it was focused on the planet Saturn during April 2009. The remedy was triturated to a 3C on July 25, 2009 by a group of 7 people in Buffalo, New York. Six of the 7 ground and scraped the milk sugar while one person took notes.

Please read the rest of “proving”. Go and read it now. I’ll wait.

This is the basis of homeopathy, and how remedies are selected. Any wonder why it was discarded by evidence-based health professionals? In the United Kingdom, the House of Commons Science and Technology Committee recently admitted that the rules drawn up to regulate homeopathic medication are based on “no scientific evidence”.  In light of the facts about homeopathy, many pharmacists (myself included) are puzzled why the Leslie Dan Faculty of Pharmacy at the University of Toronto is delivering a continuing education conference with a homeopathy manufacturer as a sponsor, and homeopathy on the agenda.  Homeopathy has no role in pharmacy practice: Its presence in  pharmacies is an embarrassment to the profession.