Naturopathy versus Science: Seasonal Allergy Edition

tilting at windmills

I glanced at my pharmacy license recently, and noticed I became a licensed pharmacist almost exactly twenty years ago. Two decades seems like a long time to do pretty much anything, yet I can still vividly recall some of the patients I encountered early in my career, working evenings in a retail pharmacy that drew heavily on the alternative medicine crowd. It was the first pharmacy I’d ever seen that sold products like homeopathy, detox kits, salt lamps, ear candles, and magnetic foot pads. And the customers were just as unorthodox. There were some that told me they manipulated their own pH, and others that insisted any prescription drug was designed to kill. And there was a huge clientele that relied on the pharmacy for their “bioidentical” hormones. It was an instructive learning experience, as it was as far from the science of pharmacy school as you could expect to find in a place that still called itself a pharmacy. One of the really interesting aspects of that pharmacy was the enormous supply of vitamins and supplements for sale. It stretched over multiple aisles and even back into the dispensary, where there were some brands kept behind the counter. This wasn’t for any regulatory reason – it was because these were the “naturopathic” supply, the brands often recommended by naturopaths. In order for this pharmacy to sell them they had to keep the products behind the counter, presumably to grant these supplements a veneer of medical legitimacy. These were “special”, and they had the prices to prove it. Continue reading

The Detox Myth: What your alternative health provider isn’t telling you

Herbal cleanse detox coffee enema sugar detox master chleanse

Happy New Year to my regular readers! Today’s post revisits some old material, repackaged and updated.

New Year, New You, right? 2014 is the year you’re finally going to get serious about your health. You’re winding down from a week (or more) of celebrations and parties. You’re pretty much recovered from New Year’s Eve by now. It’s time to make some resolutions. Conveniently, there is no shortage of solutions being advertised to absolve you of your sins while overhauling your body and soul for 2014: What you need to do is “detox”. You’ll see the detox kits at your local Whole Foods (or even your local pharmacy). Books, boxes or bottles, with some combination of “detox”, “cleanse” or “flush” in the product name. Supplements, tea, homeopathy, coffee enemas, ear candles, and footbaths all promise detoxification. The advertising suggests you’ll gain a renewed body and better health – it’s only seven days and $49.95 away. Or try to cleanse yourself with food alone: Dr. Oz is hyping his Holiday Detox plan. Bon Appetit is featuring their 2014 Food Lover’s Cleanse. Or what about that old standby, the “Master Cleanse”? It’s the New Year – wouldn’t a purification from your sins of 2013 be a good idea to start the year? After all, the local naturopath sells detoxification protocols, including vitamin drips and chelation. There must be something to it, right? Continue reading

Not an alternative to anything

Homeopathic vaccines

Health Canada approves homeopathic “nosodes” as “safe and effective” despite the fact that homeopathy is an elaborate placebo system of sugar pills based on prescientific ideas of disease. Homeopaths and naturopaths actively promote nosodes as alternatives to vaccines, despite the fact that homeopathic remedies are inert with zero ability to protect against infectious disease.

Due to lobbying by groups like Bad Science Watch, Health Canada has reluctantly agreed to label nosodes (which it approves for sale) with the caution “This product is not intended to be an alternative to vaccination”.  Is this adequate? Some are asking why nosodes are even permitted for sale at all: Continue reading

Ask the (Science-Based) Pharmacist: What are the benefits of coffee enemas?

How do you take your coffee? Rectally.

How do you take your coffee? Rectally.

It might not occur to you, sipping your morning coffee, that you could derive tremendous health benefits by simply shooting that coffee directly into your rectum. Yet many people believe this. Suzy Cohen, who calls herself, “America’s Pharmacist™” and also “America’s Most Trusted Pharmacist®” is a proponent. Her syndicated column Ask the Pharmacist recently contained this question and response: Continue reading

Intravenous vitamin injections: Where’s the evidence?

Intravenous
Vitamins are magic. Especially when they’re injected. Roll up the sleeve, find a vein, insert a needle and watch that colourful concoction flow directly into the bloodstream. It may sound somewhat illicit, but that person infusing it is wearing a white coat, and you’re sitting in a chic clinic. There must be something to it, right? Intravenous vitamin injections are popular with celebrities and have even been described by Dr. Oz as “cutting edge”. Advocates claim vitamin injections can benefit serious conditions like cancer, Parkinson’s disease, macular degeneration, fibromyalgia, depression, and that modern-day obsession, “detoxification”. And vitamin infusions aren’t just for the ill. They’re also touted as helpful for preventing illness, too. A search for vitamin injections brings up millions of hits and dozens of advertisements. There is no question that vitamin injections are popular. But despite all the hype and all the endorsements, there is no credible evidence to suggest that routine vitamin infusions are necessary or offer any meaningful health benefit. Vitamin infusions are a marketing creation, giving the illusion you’re doing something for your health, but lacking any demonstrable efficacy. What’s more concerning, providers of vitamin therapies target their marketing at those fighting life-threatening illnesses like cancer, selling unproven treatments in the absence of good scientific evidence that they are beneficial.

The intravenous vitamin industry is a sideshow to science-based health care. Yes, there is an established medical role for injectable vitamins, though it’s no energy-boosting cure-all – they’re used to replace what we should obtain in our diet. As a hospital-based pharmacist I used to prepare sterile bags of total parenteral nutrition (TPN), a mixture of vitamins, carbohydrate, protein and fat that completely replaced the requirement to eat. TPN is effective, but not without risks, and far less preferable than getting your nutrients the old fashioned way – by eating them. There’s also the routine use of injectable vitamins like B12, or iron, all of which can be science-based when used to address true deficiencies, or to manage specific drug toxicities. IV vitamins (particularly thiamine) are also used in the emergency room, given to alcohol-dependent patients in order to prevent Wernicke’s encephalopathy. And there is the therapeutic use of high-dose minerals like intravenous magnesium for acute asthma attacks. But there is no medical justification to infuse vitamins into a vein when you can more appropriately obtain those nutrients in your diet.
Continue reading

Weekend Reading

Keep the heat on Health Canada: www.bannosodes.org

Keep the heat on Health Canada: http://www.stopnosodes.org

Here’s what’s keeping this pharmacist engaged and sometimes outraged:

Health Canada explicitly puts the financial interests of homeopathy manufacturers above broader public health goals. From the BC Medical Journal, Health Canada licenses homeopathic vaccines:

Remarkably, at the same time as Health Canada focuses on influenza education, flu shots, and other proven prevention measures, that same body has licensed 10 products with a homeopathic preparation called “influenzinum.”[8] According to providers, in­fluenzinum is for “preventing the flu and its related symptoms.”[9] Homeopathic vaccines are available for other infectious diseases as well. Health Canada licenses homeopathic preparations purported to prevent polio,[10] measles,[11] and pertussis.[12] Health Canada continues to assure Canadians that it tests products for safety and efficacy before allowing them to enter the market. All approved homeopathic products are given a DIN-HM number. The website states, “A NPN or DIN-HM means that the product has been authorized for sale in Canada and is safe and effective when used according the instructions on the label.”[13]

Pharmacist John Greiss compares Health Canada and the FDA and their action on opiates. The results are striking and reiterate the question above: Is Health Canada putting public health objectives above manufacturers? Continue reading

Not effective. Not cost-effective.

Health and insurance plans usually cover the cost of anti-inflammatory drugs. But what about acupuncture? Should it be an insured benefit? How about chiropractic?  Health insurance providers and medicare programs worldwide are scrutinizing health spending. Devoting dollars to one area (say, hospitals) is effectively a decision not to spend on something else, (perhaps public health programs). All systems, be they public or private, allocate funds in ways to spend money in the most efficient way possible. Thoughtful decisions require a consideration of both benefits and costs. So where does that place complementary and alternative medicine (CAM)?

One of the central tenets of a science-based approach to healthcare is that all health interventions should be evaluated based on a consistent scientific standard. From this perspective, there is no distinct or separate practice of medical care deemed “alternative”, “complementary” or more recently “integrative”. There are only treatments and interventions which have been evaluated and found to be effective, and those that have not. So why concern ourselves with unproven and disproven products and treatments? That these treatments persist is a testament to promoters of CAM who, unable to meet the scientific standard with their products and services, have argued (largely successfully) for different (i.e., lower) standards and special consideration — be it product regulation, like the Natural Health Products Directorate in Canada, or practitioner regulation. But this doesn’t mean that their services will be paid for by health insurace.  In an environment of economic restraint in health spending, promoters recognize that showing economic value of CAM is important. Consequently they use the tools of economics like they use scientific methods and research: to argue a belief, rather than answering a question. That seems to be the case with a recent paper that’s being celebrated by alternative medicine practitioners. Entitled, Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations, it attempts to summarize economic evaluations conducted on CAM treatments. The results of the paper are enlightening – but not in a way the authors intended. Continue reading