Homeopathy: To sell or not to sell? Pharmacists weigh in

Shelf sign: Homeopathy is nonreturnable

Homeopathy is nonreturnable

Homeopathy is a popular topic here at Science-Based Pharmacy. I’ve blogged before on the ethics of the provision of these products, and argued pharmacists have an ethical responsibility not to sell, promote, or encourage the sale or use of homeopathy. It’s a question that has been put to pharmacists before. So I was I was interested to see the UK pharmacy publication Chemist and Druggist recently asked their readers about the ethics of the sale of homeopathy, setting up the scenario as follows:

You are working as a locum in a busy high street pharmacy. A customer comes in and asks about “non-drug” treatments for hayfever. The customer says she “doesn’t trust” pharmacy products and asks if you have any homeopathic remedies. The store does stock a range of homeopathic treatments, but you know they are not considered medicines by the RPS. What should you do?

I was hoping to see a discussion from pharmacists on how they’d approach a description of the products (most don’t contain a single molecule of the listed ingredient) and their efficacy (no effects beyond that of placebo) with some science-based (and perhaps non-drug) measures for allergy management. Here are some of the supportive responses: Continue reading

Burzynski Clinic? Meet the Streisand Effect

In the rough and tumble world of blogging, debate and criticism is healthy. I know I’m a better writer and blogger because the feedback from blogging is immediate and public. Yet if you’re going to blog about science, particularly pseudoscience, you’re going to encounter people who don’t share your belief in critical appraisal. And when groups and individuals cannot defend themselves with scientific evidence, they occasionally react by trying to stop that discussion from happening at all. One of the core principles of scientific skepticism is the belief that all ideas can and should be subject to fair criticism. No testable claim may escape appraisal or critique. It’s a critical component of the scientific method itself:

…at the heart of science is an essential balance between two seemingly contradictory attitudes – an openness to new ideas, no matter how bizarre or counterintuitive, and the most ruthlessly skeptical scrutiny of all ideas, old and new. This is how deep truths are winnowed from deep nonsense.

– Carl Sagan, The Demon-Haunted World, Chapter 17

Andy Lewis is a prolific skeptical blogger and inventor of the handy Quackometer, a website that analyzes any website, giving a rating based on telltale signs of quackery. Recently Andy blogged about Stanislaw Burzynski and his eponymous cancer clinic. Lewis detailed the story of a child with an inoperable brain tumor and the fundraising that is occurring to send this child to Burzynski’s clinic. The concern is that Burzynski’s cancer treatments consist of an unproven therapy he calls antineoplastons. Despite the lack of any objective evidence that antineoplastons are an effective cancer therapy, Burzynski offers this therapy under the auspices of a clinical trial. Astonishingly, patients must pay for the privilege of entering these trials – in the case of the child in question, the family is trying to raise £200,000. Continue reading

Antioxidants and Exercise: More Harm Than Good?

Multivitamin supplementation has been getting a rough ride in the literature, as evidence emerges that routine supplementation for most is, at best, unnecessary. Some individual vitamins are earning their own unattractive risk/benefit profiles: Products like folic acid, calcium, and beta-carotene all seem inadvisable for routine supplementation in the absence of deficiency or medical indication. Vitamin E, already on the watch list, looks increasingly problematic, with data recently published confirming the suspected association of supplementation with an elevated risk of prostate cancer.

When it comes to health decisions about vitamin supplements, history teaches us a valuable lesson: The danger of assuming therapeutic benefits in the absence of confirmatory evidence. Vitamin supplement have the patina of safety and of health, a feature that’s reinforced when you purchase them: You don’t need a prescription, you don’t get counseled on their use, and there isn’t a long list of frightening potential side effects to accompany the product. You can pull a bottle off the shelf, and take any dose you want. After all, how harmful can vitamins be when you can buy 5 pounds of vitamin C at a time, or vitamin E capsules in a 1000-pack? But the research signals seem to be getting stronger, and most are pointing in the same direction: what we though we knew about antioxidants was based on simplistic hypotheses about nutrition and health. And while we thought we were doing ourselves good with antioxidant supplements, we may have been doing harm. Continue reading

Toronto Star to CPSO: Don’t Muzzle Our Doctors

From the College of Physicians and Surgeons of Ontario’s consultation on “Non-Allopathic” therapies comes a revised policy [PDF, starts page 249]. It’s a significant improvement (gone are references to “allopathic”), but it’s still muddled and equivocal when it comes to advocating for a single treatment standard. The Toronto Star is unimpressed with the revision:

Alternative medicine is booming even without much proof it works. A record 20,000 people are expected at Toronto’s Whole Life Expo at the downtown convention centre next weekend. Three-quarters of Canadians regularly use some form of natural health product, opening their wallets to spend at least $4.3 billion yearly. And the herbs and homeopathic tinctures they buy are just one facet of unconventional medicine — a thriving sector encompassing everything from acupuncture to zone therapy (supposedly stimulating the body’s organs through hand or foot massage).

Ontario’s College of Physicians and Surgeons is bending to the trend with a new policy inhibiting doctors’ criticism of unconventional therapies. In doing so it risks encouraging even broader use of dubious and potentially harmful treatments.

The editorial calls it exactly right:

The college shouldn’t seek to accommodate that trend or retreat to a neutral corner. Rather it should leave doctors free to punch hard against those peddling dubious cures and to challenge people’s comforting, but irrational, beliefs. Science-based medicine serves patients best. If doctors can’t vigorously defend it, who will?

(Emphasis added)

See the full editorial here. The CPSO is poised to ratify the revised policy at their council meeting on November 28 and 29.

Collagen: An implausible supplement for joint pain

I’m one of those odd people that enjoys distance running. I end up spending a lot of time in the company of other runners. And when we’re not running, we’re usually griping about our running injuries. As the cohort that I run with ages, the injuries are getting more prevalent. Besides the acute conditions, the chronic problems are starting to appear. Our osteoarthritis years are here.

As the available pharmacist, I get a lot of questions about joint pain. What’s reassuring, I tell them, is that they shouldn’t blame running. Osteoarthritis is common — the most frequent cause of joint pain. For some, it starts in our twenties, and by our seventies, osteoarthritis is virtually certain. Regardless of your level of exercise, the passage of time means the classic osteoarthritis symptoms — joint pain and morning stiffness, that worsens over time. Continue reading

Weekend Reading

The weekend is nearly upon us. Here’s some recommended reading.

With Vaccines, Bill Gates Changes The World Again – Matthew Herper of Forbes magazine crafts an insightful profile of Bill Gates and his new work, using vaccines to improve the lives of millions:

To deliver pneumococcal and rotavirus vaccines to 250 million children, GAVI raised more than $3 billion from various governments, including the U.K., Norway and the U.S., and Gates kicked in the final $1 billion to make it all work. The results have been equally massive: 3.4 million lives saved from hepatitis B, which causes liver cancer, 1.2 million lives from measles, 560,000 from the Hib bacteria, 474,000 from whooping cough, 140,000 from yellow fever and 30,000 from polio. In the past year the new initiatives have prevented another 8,000 deaths from pneumonia and 1,000 from diarrhea.

I Flu Delta -The National Vaccine Information Center, an antivaccine organization, is running antivaccine advertisements, inflight, on Delta Airlines. The advertisement (viewable online) downplays the seriousness of influenza and encourages visits to the NVIC website, which is rife with demonstrably false statements about vaccine safety and efficacy. More at Respectful Insolence. Take a few minutes to send a message to Delta about the veracity of NVIC’s claims.

Q&A: Edzard Ernst on alternative medicine - A great interview with physican Edzard Ernst, coauthor of a book I highly recommend, Trick or Treatment. There are two exchanges here that resonated with me:

Q: A lot of people use acupuncture, yet high-level studies show that sham acupuncture is just as good as ‘real’ acupuncture. What does this tell us?

A: It shows how important the placebo effect can be, particularly if expectations are high. But we do not need bogus treatments to benefit from a placebo response. Any effective therapy also comes with a free placebo effect in addition to its specific therapeutic effects, as long as it is administered with compassion and empathy.

Q: What do you say to people who argue that conventional medicine kills more people than alternative medicine and that the latter is even more dangerous, so we should focus on this threat to public health?

A: I say it’s true but misses the point. Treatments must be judged by their risk-benefit balance. If a therapy causes some harm but, at the same time, saves thousands of lives, it still might be worth considering. Very few alternative medicines generate a lot of benefit. This means even small risks can affect the risk-benefit balance significantly.

The interview is conducted by Julia Belluz, author of the science-advocacy blog Science-ish.

DIY statistical analysis: experience the thrill of touching real data - Ben Goldacre’s weekly column in The Guardian is a must-read for me, and last week’s column, on cancer rates, funnel plots, and and the Poisson distribution was excellent. Highly recommended.

New edition of “Testing Treatments”, best pop science book on Evidence Based Medicine ever – Also from Ben Goldacre, a link to a free download of a book he describes as follows:

There are many reasons to read this book. At the simplest level, it will help you make your own decisions about your own health in a much more informed way. If you work in medicine, the chapters that follow will probably stand head and shoulders above any teaching you had in evidence-based medicine. At the population level, if more people understand how to make fair comparisons, and see whether one intervention is better than another, then as the authors argue, instead of sometimes fearing research, the public might actively campaign to be more involved in reducing uncertainties about the treatments that matter to them.
But there is one final reason to read this book, to learn the tricks of our trade, and that reason has nothing to do with practicality: the plain fact is, this stuff is interesting, and beautiful, and clever. And in this book it’s explained better than anywhere else I’ve ever seen, because of the experience, knowledge, and empathy of the people who wrote it.
Testing Treatments brings a human focus to real world questions. Medicine is about human suffering, and death, but also human frailty in decision makers and researchers: and this is captured here, in the personal stories and doubts of researchers, their motivations, concerns, and their shifts of opinion. It’s rare for this side of science to be made accessible to the public, and the authors move freely, from serious academic papers to the more ephemeral corners of medical literature, finding unguarded pearls from the discussion threads beneath academic papers, commentaries, autobiographies, and casual asides.

Huffington Post: Irresponsible mouthpiece for the World of Woo – If you’re looking for science misinformation, look no further than the Huffington Post. After a simply atrocious piece appeared in the HuffPo (“6 Medical Myths Even Your Doctor May Still Believe”) I was thrilled when Emily Willingham took it on and eviscerated it. An excerpt:

Huffington Post is notorious for publishing anti-science garbage. But I don’t think anything they’ve vomited into the Webosphere is as egregiously misleading and anti-scientific as this piece by one Robert A. Kornfeld in which he purports to let us all know exactly why your physician’s belief in the efficacy of modern medicine is a myth and in which he exposes an ignorance about genetics so profound that I may lose hope in humanity.

Science, Before Your Very Eyes! – Not a reading activity, but an event: Next week, the Lorne Trottier Public Science Symposium Series takes place in Montreal. A free event, this year’s theme is “Alternative Medicine Under the Microscope” and features Science-Based Medicine’s Harriet Hall, physician and author Paul Offit, author of the recommended book Autism’s False Prophets, as well as Edzard Ernst, profile above. If you can get to McGill University on November 7/8, it looks like a fantastic event.

Photo from flickr user Kevin McShane used under a CC licence.