Naturopathy, Paternalism and Infertility Treatments

Pregnancy Test
This is another post in the naturopathy versus science series, where a naturopath’s advice is assessed against the scientific literature.

It’s Naturopathic Medicine Week in the United States, so it’s time for another look at the alternative medicine practice that blogger Orac likes to call the One Quackery to Rule them All. Naturopathy is an oddity among alternative medicine, because it’s a hodgepodge of other practices linked by an underlying belief in vitalism: the pre-scientific notion that living things have a “life force”. Vitalism disappeared from medicine when Wöhler synthesized urea in 1828, yet the belief in vitalism is a central tenet of naturopathic philosophy. Naturopaths liken themselves to be primary care providers akin to family physicians (general practitioners) but their practices are quite different: rather than make decisions based on scientific evidence, naturopaths pick and choose based on what they feel is congruent with their vitalistic philosophy, sometimes despite good scientific evidence that shows they are wrong. For example, homeopathy is an alternative medicine practice that is very popular with naturopaths. It is an elaborate placebo system where “remedies” contain no medicinal ingredients: they are literally sugar pills. There is no demonstrable medical effect from homeopathy, and so it isn’t part of science-based medicine. Yet homeopathy is a “core clinical science” for naturopaths, and the practice of homeopathy is part of their licensing exam.

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One Simple Solution for Medication Safety

Dr. Mike Evans is a Toronto family physician, a television and radio personality, and a health communicator whose white board videos have attracted millions of views. You may be familiar with 23 and ½ hours: What is the single best thing we can do for our health? which has over 4 million views and counting. Dr. Evans has just released a great new video on medication safety that outlines a very simple way to use medications more safely, and profiles the ways a pharmacist can help. Enjoy:

Using parental guilt to sell dubious supplements

If you don't buy this for your child, they'll fail.

If you don’t buy this for your child, they’ll fail.

The supplement industry wants you to buy their products, and they’re not above using a little parental guilt to make you into a customer. In the photo above, the promoter is my local pharmacy, where the large window display caught my eye:

Give your Child The Tools to SUCCEED in School!

Who doesn’t want their child to succeed? And if you knew a supplement could give you or your child a learning edge, would you consider it? I’d imagine many do. Supplements have a remarkable health halo. As a pharmacist myself, I’ve noticed this when speaking with patients – few consumers identify any potential risk or downsides to supplement use. Some don’t even think of them as medicine at all. The marketing has resonated: Supplements are perceived as “safe”, “natural” and “effective”. But whether you’re giving your child a prescription medicine to treat attention deficit hyperactivity disorder, or you’re giving a supplement to “improve focus and brain function”, you’re still administering a chemical substance to a child with the intent of changing brain function. We’d probably think twice before pouring an unknown substance in our car’s gas tank, especially one claimed to boost performance. We’d probably ask for some evidence that it works, and some assurance it wouldn’t harm our vehicle. A decision to use a drug or supplement in a child deserves just as much consideration of benefits and risks. Continue reading

Under threat of class action lawsuit, maker of “homeopathic” medicine settles, and exits North America

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I’ve written more times that I want to about homeopathy, the elaborate placebo system of “remedies”. It looks like medicine, and pharmacies stock it on shelves alongside products that contain medicine. But with homeopathy the common “strengths” or “potencies” of products are usually so dilute there’s no possibility of a single molecule of the original substance remaining in the remedy. What’s further, the original substance isn’t medicine, either. They can be derived from from substances like Stonehenge (yes, that Stonehenge), shipwrecks, ascending colons, light bulbs, and even vacuum cleaner dirt. While homeopathic products are deemed “safe and effective” by Health Canada’s Natural Health Products Directorate, the awareness that homeopathic products contain no active ingredients and have no medicinal effects has become increasingly well known. In 2011, I noted that manufacturer Boiron had been served by two class action lawsuit, and that this might be the beginning of a trend.

The legal action route seems to be having an effect – which is good, given pharmacies and even regulators have refused to act. Homeopathy manufacturer Heel has decided to exit the North American market completely: Continue reading

Side effects of your supplement may include liver failure

liver

“Safe and natural.” It’s a marketing phrase attached to dietary supplements that’s often accepted as self-evident. The marketing works. Supplements have a strong health halo. But evidence suggests that this reputation may be undeserved. Not only are there continued questions about whether most supplements have any health benefits whatsoever, there is also evidence that they can be harmful. We can’t even be confident that what’s on the label is actually in the bottle. Just two days ago I was notified of another long list of supplements and remedies that the FDA had identified that were contaminated with prescription drugs. These warnings about products sold as supplements appear regularly. Some time ago I asked, “What’s in your supplement?“, and noted that contamination and poor product quality standards continue to raise questions about whether supplements can be used safely at all, because the harms, when they occur, can be catastrophic. No matter how you feel about their efficacy, we can probably all agree no consumer should lose an organ from taking a health supplement. But it can happen. Continue reading

The truthiness of naturopathic “facts”

LaLaLaLa

This is another post in the naturopathy versus science series, where a naturopath’s advice is assessed against the scientific literature. It’s a cross post from Science-Based Medicine, where the original post has (at last count) 436 comments:

When you think medicine, your first thought may be “physician”. But the practice of medicine today is a collaboration, as few health professionals, even physicians, can deliver health care completely independently. As a pharmacist I’ve worked closely with physicians, nurses, and other health professionals my entire career. Collaboration starts early, and the setting is usually the teaching or academic hospital, which is always crawling with students, interns, and residents from all professions. Teamwork and trust are essential. In order for different professions to work effectively together, there has to be a common foundation. For medicine, that foundation is science. From basic science principles through a common understanding of fields like biochemistry and physiology, health professionals all work from the same basic understanding about how the body works and what the principles of medicine actually are. If I give a recommendation to a physician or a nurse, I’m basing that assessment on an evidence base that we both rely on. It’s not “pharmacist evidence” versus “physician evidence”, it’s “medical evidence”. This is reality-based healthcare. Continue reading

Pharmacists and the pharmacy profession must move with the times

pharmacy

It’s time for community pharmacy to stop selling quackery, argues pharmacist Anthony Cox:

Pharmacists have long been providing advice to prescribers based on evidence. Before EBM became widely used in the 1990s, pharmacists ran medicine information centres and answered complex drug queries using the best available evidence. Pharmacists were involved in the development of EBM and its propagation via drug and therapeutics committees, and more recently working with the National Institute for Health and Care Excellence (NICE).

By its very nature, pharmacy is an evidence-based profession in both primary care and hospital care and the industry is undergoing a period of change. Future models of community pharmacy practice that focus on management of long-term conditions will place an even greater reliance on EBM.

Well, that is the case with prescribed medicines. When it comes to OTC products, pharmacists’ approach to evidence seems to be forgotten, with a “what the public wants, the public gets” attitude taking precedence.

More here

Photo from flickr user jeepersmedia used under a CC licence.

Which prenatal vitamin is best?

Pregnant2

Vitamin supplementation is unnecessary for the vast majority of people. You wouldn’t know this walking through a drug store, where you’ll usually find an entire aisle packed with supplements. Alternative health providers like naturopaths tend to be strong supporters of supplementation, but this advice seems to be based mainly on the belief that “vitamins are magic” rather than good science. The best research hasn’t established a strong evidence base for taking supplements. We definitely need vitamins in our diet to live. But that’s where we should be getting those vitamins – from our food, instead of from pills. If you eat a reasonable and balanced diet, and have no medical conditions that require special consideration, vitamin supplementation won’t offer meaningful health benefits. In the absence of any deficiency, vitamin supplements seem to be useless at best and harmful at worst. Continue reading