The HCG Diet: Another ineffective and possibly dangerous diet plan

I could easily devote every post to writing about weight loss supplements, and never run out of topics. As soon as one quick fix falls out of favour, another inevitably replaces it. Some wax and wane in popularity. And pharmacies don’t help the situation. I cringe every time I walk down the aisle where weight loss products and kits are located. Detox? Hoodia? The “fat blaster”? Here are pharmacists, well educated and perfectly positioned to provide good advice to consumers, but standing behind a wall of boxes with ridiculous weight loss promises. Yet my colleagues tell me that these products are not only sought out by customers, but they actually sell well. It’s a lost opportunity to provide good advice, and consumers pay the price.

Perhaps because consumers associate these products with pharmacies, I get regular questions about weight loss programs. I end up developing some degree of familiarity with many of them, if only to be able to credibly redirect away from some of the more harmful plans and approaches. It’s that philosophy that I used recently when I was asked about how to best to manage a “plateau” on the HCG diet. I’d never dispensed human chorionic gonadotropin (HCG) before, but knew of its use for the treatment of infertility, where it promotes egg release. But weight loss? I couldn’t think of a mechanism for how HCG could promote weight loss. So I did some digging, and found a long, rich vein of pseudoscience that dates back decades. Continue reading

Do pharmacy regulators “get” homeopathy?

Epic Facepalm

It’s on almost every pharmacy’s shelves. I’ve written at length about the problems with homeopathy in pharmacies. In fact, it was the subject of my very first post, over three years ago, where I described how homeopathy is an elaborate placebo system, with “remedies” that contain no active ingredients. Homeopathy was “invented” in the late 18th century, and is effectively a vitalistic belief system that rejects established facts about biochemistry, physics, and pharmacology. If homeopathy works, then real medicine as we know it cannot work. Over several posts, I’ve detailed the problems with the pharmacist provision of homeopathy: Continue reading

Developing your scientific skepticism: The Middle Ground Fallacy

Poor reasoning is common, even among those with scientific backgrounds. But you too can become a scientific skeptic. The other night on Twitter, pharmacy student and self-proclaimed skeptic Ciara Ní Chionnaith asked the following question:

Skeptics – was there a particular turning point after which you became skeptical? After an experience, a book, meeting/hearing someone etc?

For me, there were two turning points. The first was discovering the Respectful Insolence blog – the only place I could initially find science-based thinking on pharmacy-sold products like homeopathy. Shortly after I started following the blog, I read Carl Sagan’s The Demon Haunted World – Science as a Candle in the Dark, which I’ve reviewed before. There was no turning back, then. This book was eye-opening, to say the least. Not only did it force me to question assumptions I’d held for most of my life, it completely changed my mindset and philosophy about the importance of science and the scientific process. Sagan’s book is a truly essential read for anyone that is interested in finding out more about scientific skepticism. I can’t recommend it enough.

There were a number of other excellent responses to Ciara’s post, which I’ve Storified for your reading interest.

After reflecting on Ciara’s post a bit more, I thought it might be interesting and helpful to readers to do some short posts highlighting common logical fallacies that are routinely seen in health and medicine. As you become a scientific skeptic, spotting logical fallacies is easy. But it takes time to learn them, and to spot them when they’re in use. I’ve noted many in prior posts, but today’s article in the BMJ from Edzard Ernst is a good place to start. I’m a big fan of Dr. Ernst – his book, Trick or Treatment, written with Simon Singh is another essential read, particularly for pharmacists.  His post today was on the “Middle Ground Fallacy” which is also called the “False Balance” fallacy:

When we are confronted with two opposing views, we tend to look for the comfort of the middle ground hoping the truth might lie somewhere between the two extremes. For instance, if someone describes a play, a book, or a restaurant as brilliant and another person thinks it is awful, we might feel that, in fact, it probably is of moderate quality.

But, in many areas, this simplistic logic does not apply. If someone says the earth is flat and another person insists that it is a sphere, we cannot very well conclude the truth lies somewhere in the middle. Facts are facts and disagreements about facts cannot be settled by half-truths or semi-facts.

Middle ground reasoning is endemic in media coverage of many alternative health practices, whether it’s homeopathy, useless laboratory tests, or diet products. Arguments that there is a “middle ground” between homeopathy not working and working are fallacious, given the overwhelming scientific evidence that homeopathy is inert and has no meaningful biologic effects. In the same way, proponents for IgG food intolerance claim that testing is “evolving” or that anecdotes are relevant when there is no published evidence to demonstrate it is useful, and there is good scientific evidence to demonstrate it is useless. Yet when these topics are discussed in the media, often unscientific perspectives are given equal consideration, even though one may be completely unsupported by scientific facts. Creating a middle ground with false balance is a way of creating a debate, when in fact there is no scientific debate at all. Homeopaths will argue that homeopathy is effective, but from a scientific perspective, there is no uncertainty at all about it, or its lack of effects.

These type of arguments remind me of this classic Dara O’Briain clip (the key point starts at 1:00):

One of the few areas in science and medicine where the middle ground is less frequently observed is in discussions of vaccine safety. Over the past few years there has been a significant increase in general awareness that antivaccine positions are not based in credible science – and antivaccine advocates don’t argue in good faith. Consequently, less consideration is now given to antivaccine viewpoints – which, from a scientific evidence perspective, is the right approach.

The key point for the developing skeptic to keep in mind is that the “middle” (however defined) is not always the wrong answer. In areas of legitimate scientific debate, a moderate position may be correct. But a middle position, just like any position, must be supported by good evidence. So when the science is clear, and the facts are on your side – don’t equivocate, and don’t yield to a middle ground.

More reading:

Edzard Ernst: The “middle ground” fallacy
Fallacy: Middle Ground
Your logical fallacy is: middle ground

Photo from flickr user miheco under a CC licence.

 

Green Coffee Beans for weight loss: Dr. Oz loves it, but where’s the evidence?

Green Coffee Beans - Fake Cures For Real Conditions

I can’t keep up with Dr. Oz. Just when I thought the latest weight loss miracle was raspberry ketone, along comes another panacea promising results with no effort. This time, it’s green coffee beans.

Everyone knows Dr. Oz, now. Formerly a guest on Oprah, he’s got his own show which he’s built into what’s probably the biggest platform for health pseudoscience and medical quackery on daytime television. In addition to promoting homeopathy, he’s hosted supplement marketer Joe Mercola several times to promote unproven supplements. He has been called out before for promoting ridiculous diet plans, and giving bad advice to diabetics. And don’t forget his failed attempt to actually demonstrate some science on his show, when he tested apple juice for arsenic which prompted a letter from the FDA about his shoddy methodology. His extensive track record of terrible health advice is your caution not to accept anything he suggests at face value. Yet it continues to frustrate me that pharmacies see his endorsements as a boon for sales of supplements, rather than what they really are  – an obstacle to science-based health care. So when the sign in front of my local pharmacy started advertising “Green coffee beans – as seen on Dr. Oz”, I tracked down the clip in question. The last time I saw Dr. Oz in action when when he had Steven Novella from the Science-Based Medicine blog as a guest, where there was actually a exchange (albeit brief) about the scientific evidence for alternative medicine. Replace Dr. Novella with a naturopath, and you get this: Continue reading