SBP enters it’s sixth year in 2014. Thanks for the support and you advocacy for professionalism and science in pharmacy practice.
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Among the many forms of supplementation that I’m asked about, multivitamins are the source of the most confusion among consumers. Multivitamins are marketed with a veneer of science but much of that image is a mirage – rigorous testing doesn’t support most of the outlandish health claims that are attributed to them. Yet not all vitamin and mineral supplementation is useless. They can be used appropriately, when our decisions are informed by scientific evidence: Folic acid prevents neural tube defects in the developing fetus. Vitamin B12 can reverse anemia. Vitamin D is recommended for breastfeeding babies to prevent deficiency. Vitamin K injections in newborns prevent potentially catastrophic bleeding events. But the most common reason for taking vitamins isn’t a clear need, but rather our desire to “improve overall health”. It’s deemed “primary prevention” – the belief that we’re just filling in the gaps in our diet. Others may believe that if vitamins are good, then more vitamins must be better. And there is no debate that we need dietary vitamins to live. The case for indiscriminate supplementation, however, has not been well established. We’ve been led to believe, through very effective marketing, that taking vitamins is beneficial to our overall health – even if our health status is reasonably good. So if supplements truly provide real benefits, then we should be able to verify this claim by studying health effects in populations of people that consume vitamins for years at a time. Those studies have been done. Different endpoints, different study populations, and different combinations of vitamins. The evidence is clear. Routine multivitamin supplementation in most people has not been shown to offer substantial health benefits.
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Tags: cardiovascular disease, Centrum, dementia, multivitamins, PHS II, TACT, USPSTF
Once again, it’s influenza season. The vaccine clinics are open, and the hysterical posts about the vaccine’s danger are appearing in social media. There’s familiarity to all of this, but also a big new change – at least in Canada, where I am. Pharmacists can now administer the vaccine. And it’s completely free to anyone in Ontario (where I am), so the barriers to obtaining the vaccine are pretty much eliminated. There’s no longer a need to drag your kids to their family doctor or line up at a public health clinic. Anyone can walk into a pharmacy, show their health card, and walk out minutes later, vaccinated. It’s another enabling change that may help improve immunization rates, as uptake rates in the population remain modest.
This year’s flu season is (as of week 47) fairly quiet. Google Flu trends suggests a fairly typical picture, nothing like what we saw in 2009/10, the year of H1N1. My city’s influenza tracker reports only a dozen cases so far this season. Many of us will get our flu shot, continue with our lives, and not think about the flu until next season’s announcements. That’s the hope, anyway. Influenza can kill, and in its more virulent forms, is devastatingly deadly. The worst case scenario (so far) is almost unimaginable today. In 1918/19 an influenza pandemic killed 50 million people worldwide (5% of the population). So among public health professionals, that worry about the next wave is always present. Much has been written at this blog and at Science-Based Medicine on the efficacy and safety of the flu vaccine. In short, the vaccine is effective for both individual and population-level protection, but only modestly so, and its effectiveness varies based on its match with circulating strains. And despite widespread use for decades, there are frustrating limitations with the current vaccine beyond efficacy, including the need to repeat the shot annually. Donald Rumsfeld once said, “You go to war with the army you have—not the army you might want or wish to have at a later time.” The quote is relevant to influenza. The flu vaccine is not a perfect vaccine, but it does offer protection – if not directly to you, then indirectly to those at greater risk of infection. Hospitals and health facilities have been criticized for demanding health professionals either get the vaccine or wear a mask – and the arguments against vaccination are losing. But even the strongest advocates of influenza vaccine will acknowledge its limitations, which perhaps contributes to the understandable perception that there is more that could be done- beyond reasonable and effective precautions like handwashing and hygiene. Continue reading ‘“Alternatives” to the flu vaccine are no alternative at all’
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Tags: engystol, gripp, gripp-heel, Heel, homeopathy, oil of oregano, orthomolecular, oscillio, oscilliococconium, oseltamivir, pascoleucyn, Tamiflu
I’ve written repeatedly that the decision to use homeopathy is a decision to do nothing at all. Homeopathy is an elaborate placebo system where “remedies” contain no medicinal ingredients and are effectively and literally sugar pills. Given there is no demonstrable medical effect from using homeopathy, I’ve argued strongly that the sale of homeopathy in pharmacies is not only misleading to consumers, it is fundamentally unethical behavior from a health professional. What’s further, an ethicist has pointed out that pharmacists have an ethical responsibility to disclose the scientific facts about homeopathy. Selling homeopathy in pharmacies contributes to the perception that what is effectively a belief system may have some scientific legitimacy. That’s why I’m an advocate for pharmacy distancing itself from anything to do with homeopathy, because it has no potential to help and a real potential to harm.
So when homeopathy is used in place of real medicine, the risks are real. From Calgary, an avoidable child death has been linked to the use of homeopathy instead of medicine:
The family of a Calgary woman facing criminal charges in connection with the death of her seven-year-old son say they’re in shock over the allegations of neglect. The boy, Ryan Alexander Lovett, died last March after suffering from a strep infection which kept him bedridden for 10 days. Police allege his mother, Tamara Lovett, 44, chose to treat the bacterial infection with homeopathic herbal remedies instead of taking him to a doctor. That decision likely killed the child, police say.
“It was a belief system in homeopathic medicine that contributed to this death,” acting Staff Sgt. Mike Cavilla said. “It should absolutely serve as a warning to other parents. The message is simple: if your child is sick, take them to the doctor.”
The single mother, who lived in a Beltline basement suite, shunned conventional treatment to follow her belief in holistic remedies. In fact, police say there is no record of the boy ever being taken to the doctor for annual checkups or any treatment. “We have no medical record of his entire life,” said Cavilla.
A culture that grants medical legitimacy to homeopathy increases the risks of harms. Medicine has its risks and benefits, but it delivers the goods. There isn’t a single reproducible example of homeopathy effectively treating anything, ever. How could it? The treatments are inert. Yet Health Canada licenses homeopathic “remedies” as “safe and effective”, even going so far to grant unique identification numbers to indistinguishable sugar pills. And provinces are granting new powers to alternative-to-medicine providers, like naturopaths, that include homeopathy in their services.
Regrettably, this isn’t the only case of homeopathy leading to bad medical decisions. What’s the Harm? catalogs over 400 cases. This case in Calgary reminds me of the horrific case was that of infant Gloria Thomas in Australia who died of eczema (eczema!), simply because her parents refused to use medication, and relied on homeopathy. Her father, a homeopath, and her mother, were eventually convicted of manslaughter. Time will tell what becomes of this case in Calgary. It appears it was as avoidable as Gloria Thomas’ death:
An autopsy revealed he died as a result of a Group A Streptococcus infection. After consulting medical experts and the Crown prosecutor’s office, police arrested the woman at home Friday. She faces charges of criminal negligence causing death and failing to provide the necessities of life. In Canada, it is illegal for a parent or guardian to deny children food, shelter, care and medical attention necessary to sustain life and protection from harm. “If you do not provide medical attention for your sick child, you will be held accountable,” said Cavilla. “The legal requirement is that she get medical attention through traditional western medicine to deal with the illness. And in this case it was a bacterial infection that could have been easily treated with antibiotics such as penicillin.”
The death of a child is tragic. When that death was preventable, it’s infuriating. This tragedy, along with the hundreds of others, illustrates the real harms of perpetuating the belief in the magical thinking that is homeopathy.
Photo via the excellent Skeptical Raptor.
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It is a triumph of marketing over evidence that millions take supplements every day. There is no question we need vitamins in our diet to live. But do we need vitamin supplements? It’s not so clear. There is evidence that our diets, even in developed countries, can be deficient in some micronutrients. But there’s also a lack of evidence to demonstrate that routine supplementation is beneficial. And there’s no convincing evidence that supplementing vitamins in the absence of deficiency is beneficial. Studies of supplements suggest that most vitamins are useless at best and harmful at worst. Yet the sales of vitamins seem completely immune to negative publicity. One negative clinical trial can kill a drug, but vitamins retain an aura of wellness, even as the evidence accumulates that they may not offer any meaningful health benefits. So why do so many buy supplements? As I’ve said before, vitamins are magic. Or more accurately, we believe this to be the case.
There can be many reasons for taking vitamins but one of the most popular I hear is “insurance” which is effectively primary prevention – taking a supplement in the absence of a confirmed deficiency or medical need with the belief we’re better off for taking it. A survey backs this up – 48% reported “to improve overall health” as the primary reason for taking vitamins. Yes, there is some vitamin and supplement use that is appropriate and science-based: Vitamin D deficiencies can occur, particularly in northern climates. Folic acid supplements during pregnancy can reduce the risk of neural tube defects. Vitamin B12 supplementation is often justified in the elderly. But what about in the absence of any clear medical need? Continue reading ‘Do vitamins reduce the risk of cancer or heart disease?’
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Tags: cancer, cardiovascular disease, multivitamins, USPSTF, vitamin supplements, vitamins
A shorter list of links today: Continue reading ‘Weekend reading’
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If there is one aspect of “alternative” medicine that both critics and fans should agree on, it’s that products should be manufactured to high standards. What’s on the label should accurately describe what’s in the bottle. Product quality standards are essential, whether you’re using herbs or drugs. And when it comes to ensuring the products we buy are of high quality, we’re all effectively reliant on regulation to protect us. As a pharmacist, I can’t personally verify that each tablet in your prescription contains the active ingredient on the label. I am dependent on a supply chain that may stretch around the world. While the product manufacturer may be reputable, it’s only a regulator that can realistically verify and enforce production to strict quality standards. The same cannot be said for products like supplements and herbs which are regulated differently than drugs, and held to different, and in some cases, weaker standards. A weak regulatory framework, which doesn’t hold manufacturers to account, would be expected to result in a product of lower quality. And that’s exactly what you see when you look at supplements on the market today.
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Tags: DSHEA, health canada, herbal supplements, natural health products regulations