Mulberry Zuccarin Side Effects

The Science-Based Pharmacy post about Mulberry Zuccarin has become the most read article, by a big margin.  We’re pleased this evidence review has found a wide audience. However, it’s concerning that many consumers seem to be searching for information about mulberry leaf extract side effects, and adverse events associated with Mulberry Zuccarin. Some have posted their concerns in the comments, or have contacted this blog directly.

Please report any potential  adverse effects from Mulberry Zuccarin, or any other mulberry extract you take, to regulators in the country where you live. Only by reporting adverse events can cause and effect be properly evaluated. In general, natural health products are poorly evaluated, with few even undergoing randomized controlled trial evaluation. Consequently, the side effect profile may not be understood.  It is very difficult to establish a causal relationship from any product based on individual casse reports. Only with multiple reports can possible safety signals be identified. Continue reading

Slipping through the Cracks: Health Canada, Traumeel, and Homeopathy

It’s World Homeopathy Awareness Week. Today’s post is a deeper dive into the world of homeopathic “evidence”. Looking at the science, we’ll highlight the implications of regulators applying two sets of standard to health products: One for medicine, and one for homeopathy. Today’s post is a collaboration with Kim Hebert, who blogs at Science-Based Therapy.

The kindest that can be said about most homeopathic products is that they won’t cause adverse effects. After all, most common “strengths” or “potencies” used in homeopathy are so dilute there’s no possibility of a single molecule of the original substance remaining in the remedy. But what if, instead of diluting a product the typical 30 times, it’s only diluted once or twice? Is it still homeopathy? There’s a very good chance of some molecules of the original substance remaining. That’s the case with today’s case study, Traumeel. Continue reading

Remedy Regulation: Homeopathy in Canada

It’s World Homeopathy Awareness Week. Today’s post examines the Canadian regulatory framework for homeopathic remedies.

Homeopathy is an alternative medicine system that was invented in the 1800′s and involves three main concepts: like-cures-like (what causes a symptom can cure a symptom); individualized treatments (remedy selection considers factors like emotion and mood); and less-is-more (water has memory, and substances that are progressively diluted (and shaken) become stronger, not weaker.) If homeopathy worked, what is known about biochemistry, physics, and pharmacology is wrong. As expected, upon rigorous examination, there is no convincing evidence that effects attributed to homeopathy are anything more than placebo effects. Yet not only are homeopathic products sold in Canada, their sale is regulated by the federal government, through Health Canada’s Natural Health Products Directorate. And we are assured of of the following:

Through the Natural Health Products Directorate, Health Canada ensures that all Canadians have ready access to natural health products that are safe, effective and of high quality, while respecting freedom of choice and philosophical and cultural diversity. [emphasis added]

So, what gives? Science has established that homeopathy is no more effective than a placebo. How did Health Canada determine otherwise? Continue reading

Homeopathy and Consumer Protection

Editor’s Note: It’s World Homeopathy Awareness Week.

Today’s guest post is from Dr. Chris MacDonald, PhD. Dr. MacDonald is Associate Professor, Department of Philosophy, Saint Mary’s University, and a Nonresident Senior Fellow at Duke University’s Kenan Institute for Ethics. Dr. MacDonald blogs at the Business Ethics Blog.

What should we think about homeopathy, from the point of view of Business Ethics? We can begin by asking the same questions about homeopathy as we would ask about any other product. Those questions fall under two main headings:

  1. Is it generally ethically OK to sell this product? Is it a product that should be on the market at all?
  2. If it’s generally ok to sell this product, what are the obligations of companies selling them? Are there any ethical limits on how or to whom they are marketed?

In a free society, there’s a general presumption in favour of free commerce. If Party A has a product and says to Party B, “Hey, you might like this,” and if Party B says, “Hey, I think I’d like some of that, here’s some money!” then they should generally be free to make the transaction. But there are limits. Some things cannot ethically be bought or sold (children or votes, for example). Other things can be sold, but only under special circumstances (cigarettes and alcohol, for example). And more generally, there is a very broad requirement that all transactions must be carried out without force, fraud, or deception.

Now, discussions over alternative therapies like homeopathy tend to be combative, rather than constructive, particularly on the Internet. That’s unfortunate, because a lot is at stake. Finding ways to have a constructive discussion is essential, but few make that effort. But there is common ground in the debate, and we should make good use of it. Both sides of the debate agree, for example — indeed they ethically have to agree — on the importance of consumer protection, though they may disagree on the right way of achieving it. Health is complex, and important, and the average consumer typically needs to be able to turn to experts to get good advice. There are plenty of unscrupulous individuals and companies out there willing to try to make a fast buck by preying on the gullible or the uninformed. Anyone who truly cares about health has to recognize that that’s a serious problem.

So, let’s look at homeopathy through the lens of consumer protection. Most generally, consumer protection means, first, making sure that products are safe (or “safe enough”, since almost all products carry at least some risk), and, secondly, making sure that products do what the manufacturer or seller says they’ll do.

Although I happen believe that homeopathy (like most other alternative therapies) does not in fact work, I want to have a constructive discussion about consumer protection with those who think it does. So I’m going to assume, for the sake of argument, two things that many skeptics are likely to deny.

  1. First, I’m going to assume that homeopaths (and supporters) genuinely believe in the power of homeopathy. That is, I’m going to assume that most homeopaths are not outright frauds. (Actually, that’s not just for the sake of argument. I strongly believe that to be a justified assumption. I strongly suspect that the vast majority of homeopaths and homeopathic pharmacies are 100% well-intentioned, and seek only to promote the health of their patients and customers.)
  2. Secondly, I’m even going to assume — again for the sake of constructive argument — that homeopathy works. I’ll assume that the anecdotes of homeopaths and their patients confirms the positive effects that Randomized Controlled Trials have thus far been unable to detect.

Next, given these assumptions, I’m going to pose two questions for homeopaths to answer, questions that I would likewise pose to any other kind of reputable business, especially any other reputable business in the field of health.

  1. How do we detect phoney homeopathic preparations? In order to protect consumers, we need to be able to detect fake remedies — fake versions (sold by counterfeiters) that are really just inert look-alike copies of genuine remedies. In an age of international trade and Internet-based pharmacies, phoney pills are a big problem. So, is there any way to test a homeopathic preparation to verify that it is genuine? If I buy homeopathic tablets, is there any test that can be done to see if they’re real or counterfeit? If authorities suspect a criminal organization of selling fake homeopathic tablets, how can they tell the difference between the criminal organization’s tablets and those manufactured by an honest homeopathic pharmacy?
  2. What advice would you give a potential patient/customer who is trying to choose among various alternative therapies? How should a potential customer/patient choose between homeopathy, Therapeutic Touch, acupuncture, Angel Therapy, and so on? In other words, how can consumers know that they’re about to buy something good, rather than something bogus? “Trust me” won’t do as an answer. Trust, in itself, is neither a good nor a bad thing; what we value is justified trust. What is it that justifies consumers in trusting you, rather than someone else? “Try it” also isn’t a good answer. When health is on the line, we shouldn’t have to experiment on ourselves. We should have some assurance ahead of time. Consumers deserve that. One alternative, of course, is to deny that this is an important question at all, by claiming that literally all alternative therapies work. But that would make little sense. There surely are fraudsters out there, offering stuff they know can’t work. And even ignoring outright fraud, the homeopathic philosophy claims to have identified the true nature of disease; other philosophies, it seems then, must have it wrong. Which ones? Consumers deserve your input on this important issue.

These are questions I expect any reputable business to be able to answer. They are also questions to which I have not yet heard homeopaths give good answers. (In fact, I asked a version of the 2nd question on my blog, with depressing results.) I’m honestly interested to hear any an answer.

In the end, what I’m really looking for here are reasonably generalizable standards of consumer protection across various categories of health products. What standard of evidence and safety should be applied to products offered for sale, quite generally? If homeopathic preparations are not expected to stand up to the rigours of Randomized Controlled Trials, why, in all fairness, should the products of the major pharmaceutical companies be forced to meet that standard? Surely Merck and GlaxoSmithKline would love to avoid having to jump through those hoops. Surely Big Pharma would love to be able to give vague answers to my questions above. But we don’t let them. And we’re right not to let them. The question is, can the Homeopathic industry demonstrate its commitment to ethics by giving clear answers, too?

Chili Burn: Can Green Tea and Chili Pepper Burn Fat?

Diet products are common in most pharmacies. Consumer demand is one factor, with obesity proliferating to the point where the majority of Canadian adults are now overweight or obese. Compounded with the reality that there are no easy solutions when it comes to weight loss, the weight loss industry is working overtime developing new products. Some healthy skepticism is called for, on the part of both consumers and pharmacists. Given the prevalence and accessibility of pharmacies, pharmacists are well positioned to play an important role in helping the overweight and obese.

Let’s review one product advertised widely in Canada: Chili Burn from the manufacturer New Nordic. The ad has the headline “I hated the extra pounds on my body!” “I’m am really surprised how well the Chili Burn tablets worked!” The ad then makes the following claim:

The product increases the amount of calories your body uses in a day, without any needed dietary changes or added exercises. As your body burns and wastes more calories, you steadily but surely, lose weight.

It sounds too good to be true. Continue reading

World Homeopathy Awareness Week is Coming

It’s time for fantasy unlike anything you’ve seen seen since your last trip to Disney. That’s right, it’s time to discuss the most implausible of alternative health treatments, homeopathy.

World Homeopathy Awareness Week (WHAW), April 10-16, is apparently designed to introduce homeopathy to new, gullible, audiences. This year’s theme is “Homeopathy and Mental Well-being: Body and Mind in Balance”. You can check out the list of activities across Canada including homeopaths that advocate water homeopathy for depression, anxiety, eating disorders, and more.

If you’ve been following Science-Based Pharmacy for some time, you probably realize we’re not impressed with homeopathy, or with pharmacists that sell it. For WHAW, we’re going to look at homeopathy from a few different perspectives:  The responsibility of pharmacists, the responsibility of regulators, and the ethical perspective, where SBP will have a guest post from an ethicist. We’ll also look at the science behind a pharmacy product that you might not realize is homeopathy.  In addition to all the activity here, look for a full week of homeopathy-related posts from the team of bloggers over at Skeptic North.

It hasn’t been a good year for homeopaths, with the UK House of Commons Science and Technology Committee determining homeopathy to be a “placebo”; the 10-23 protesters undertaking a mass overdose of homeopathy (where precisely nothing happened); and New Zealand homeopaths admitting that their products contain no material substances.

In preparation for WHAW, take a look at some of the videos that Science-Based Pharmacy has featured over the past year. (Email viewers will need to visit the website to see the links).

Mitchell and Webb take a look at a homeopathic hospital:

And this video, which puports to explain the mechanism of homeopathy, is a must-see.  And no, it’s not a parody.

Singh vs. the BCA: A Libel Reform Update

I’ve blogged in the past about the case of Simon Singh who has been sued by the British Chiropractic Association (BCA) for making the following statement:

The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

Rather than refute Simon’s comments with evidence to substantiate their claims, the BCA decided to sue. When organizations seek to supress debate and discussion about science by using legal means, it causes “libel chill”, where speech is suppressed by fear of legal action. Singh’s case is the impetus to a campaign for libel reform in the United Kingdom, where libel laws are horrendous, putting the onus and the costs solely on the defendant. An initial ruling went against Singh, and he appealed. Yesterday’s ruling was in his favour, and will allow Singh to use a “fair comment” defence in his arguments.

What was very encouraging for Singh, and for all who comment on the legitimacy and credibility of scientific matters, was the following comment from the Court:

’34. We would respectfully adopt what Judge Easterbrook, now Chief Judge of the US Seventh Circuit Court of Appeals, said in a libel action over a scientific controversy, Underwager v Salter 22 Fed. 3d 730 (1994):

“[Plaintiffs] cannot, by simply filing suit and crying ‘character assassination!’, silence those who hold divergent views, no matter how adverse those views may be to plaintiffs’ interests. Scientific controversies must be settled by the methods of science rather than by the methods of litigation. … More papers, more discussion, better data, and more satisfactory models – not larger awards of damages – mark the path towards superior understanding of the world around us.”‘

You might be asking – What does this case have to do with Science-Based Pharmacy? Quite a bit. It’s essential for health professionals to have the freedom to comment openly about the scientific evidence supporting any drug, treatment or health intervention. Criticizing data (or the lack of data) is fair comment.  Data and evidence should determine which treatments are deemed credible – not legal threats to silence critics.

It’s too early to declare victory, as Singh points out himself  in today’s Guardian column. The BCA could still appeal. But this entire saga has been such a public relations disaster for chiropractors worldwide. As press coverage has grown, so has the scientific and mainstream scrutiny of chiropractic. And it hasn’t been positive.

The battle for free speech and fair comment continues. Sign the petition at www.libelreform.org.

For more comment and discussion on yesterday’s ruling: Kim at Skeptic North; Orac at Respectful Insolence; Jack of Kent.