Welcome to Pharmacy 2.0

It’s the not-so-distant future. A new patient tells you that he’s been reading reviews of your pharmacy online. He suffers from a chronic disease and your pharmacy’s specialty services were recommended in an article by a local blogger. Later that day, while you’re talking with a new mom about the safety of routine immunizations for her children, she references Facebook, YouTube and something she calls “mommy blogs” when discussing concerns over autism and seizure disorders. After work, you’re introduced to a local physician at the gym who has just opened a new practice. You ask for her business card, and she replies, “I’m on LinkedIn.” That night, the local news reports the results of a huge research trial. Anticipating phone calls and questions when you get to work tomorrow morning, you wonder where you can quickly find some of the experts’ thoughts on this new data.

How can pharmacists adapt to, and successfully use, social networking? That’s the topic of an article written by Kelly Grindrod and me just published in the latest edition of the Canadian Pharmacists Journal. Go check it out.

Reality Bites for Andrew Wakefield

It’s not a surprise. It’s about six years overdue.  Andrew Wakefield will lose his medical license. Yes, the (in)famous Andrew Wakefield, the individual that started the modern antivaccination movement, and drove measles to become endemic in the United Kingdom again, will no longer be practicing medicine in the United Kingdom.  It’s all the result of his discredited (and now fully retracted from the medical literature) 1998 Lancet paper that attempted to link gastrointestinal symptoms in children to the administration of the MMR vaccine, an argument that was shown to be specious.

The full judgment from the General Medical Council is available, and it’s a scathing summary of Wakefield’s behavior. It’s important to note that Wakefield did not lose his license because of his theories about the MMR vaccine and autism.  It was because of his dishonest and unethical behavior in the conduct of his research. To recap, findings included:

  • Wakefield accepted £50,000 to act as an expert on the MMR vaccine, before beginning his research.
  • Wakefield had also previously filed for patents, including for his own single vaccine.
  • He never received research ethics board approval for the work he undertook.
  • He conducted a number of invasive studies in children, including spinal taps (lumbar punctures) that were medically unnecessary.
  • Wakefield was the lead author of the paper which appeared in the Lancet in 1998. In that paper, he failed to disclose that the child subjects had been investigated directly for the purpose of identifying a link between the MMR vaccine and gastrointestinal disease. This resulted in a misleading description of the patient population. The council noted:

In the paper, Dr Wakefield failed to state that this was the case and the Panel concluded that this was dishonest, in that his failure was intentional and that it was irresponsible.

  • The Lancet paper stated the children were consecutive referrals to the hospital’s Department of Pediatric Gastroenterology. This was not the case:

In those circumstances the Panel concluded that the description of the referral process was irresponsible, misleading and in breach of Dr Wakefield’s duty as a senior author.

  • Subsequent to the publication Wakefield had multiple opportunities to correct the multiple misleading statements in the paper. He did not provide these corrections.
  • Wakefield also used a child’s birthday party as an opportunity to obtain blood samples, again without any ethical approval:

Dr Wakefield caused blood to be taken from a group of children for research purposes at a birthday party, which the Panel found to be an inappropriate social setting. He behaved unethically in failing to seek Ethics Committee approval; he showed callous disregard for any distress or pain the children might suffer, and he paid the children £5 reward for giving their blood.

And here’s the Council’s conclusion:

Accordingly the Panel has determined that Dr Wakefield’s name should be erased from the medical register. The Panel concluded that it is the only sanction that is appropriate to protect patients and is in the wider public interest, including the maintenance of public trust and confidence in the profession and is proportionate to the serious and wide-ranging findings made against him.

To summarize, Wakefield conducted unethical and shoddy research on children to further a line of evidence he stood to profit from. Despite multiple opportunities to correct his data, he continue to advance a hypothesis that was unsupported by the finding from his own work. One might hope that this draws the Wakefield chapter to a close, but I doubt it will be that simple. Wakefield had already achieved martyr status among the antivaccination crowd. He’s got a book in the works, and is on the speaker circuit, talking about the dangers of vaccination programs.

For those of you that prefer pictures to text, check out this amazing comic strip from Darryl Cunningham about the Wakefield saga. It sums up this unfortunate public health debacle with far more brevity and eloquence.

Upcoming Talk: Why Do We Make Bad Health Care Decisions?

I’ll be speaking on Friday, May 28, in Toronto, at the Centre for Inquiry about how science advocates can help support better decision-making about health:

Despite the dramatic improvements in the extent and quality of our lives, largely owing to modern medicine, our current health care system has fostered a backlash, manifested in part by the emergence of non-science-based “alternative” health care practices. This trend has driven a need for dialogue on how best we should balance evidence-based decisions against demands for consumer choice – regardless of the science. In this presentation, Scott Gavura will discuss how health care decision-making differs from other goods and services, and how this impacts on the choices we make, both as individuals, and in aggregate. Through an interactive discussion, he will facilitate a dialogue on the opportunities for science advocates to effect positive change in health at the patient- and population-level.

The talk is great value-for-money: $5, $4 for students, FREE for CFI Members.

Details here, and if you want to RSVP on Facebook, you can do that here.

Rx, OTC, BTC – Wading into Pharmacy’s Alphabet Soup

Cross-posted from Science-Based Medicine.
Imagine you’re an FDA reviewer looking at a new drug application. Drug A relieves a symptom, but doesn’t cure any disease. It doesn’t conflict with other medications. It’s considered safe in pregnant and breastfeeding women. At normal doses, there are virtually no side effects. There’s one unfortunate problem: If you take ten times the dose, liver damage is very likely and may be fatal. In other countries, Drug A is the number one cause of acute liver failure.

Should Drug A be available without a prescription?

Now consider another drug. Drug B also treats a symptom, but can also be used to treat a number of acute and chronic conditions, some of which require monitoring by specialist physicians. Drug B should generally be avoided in children, as it is associated with a rare but fatal toxicity. Even at normal doses, it can cause an array of side effects, and severe digestive system toxicity, resulting in hospital admission, is not uncommon. It interacts with other prescription drugs, and can be fatal in overdose situations.

Should Drug B be available without a prescription?
Continue reading

New Gig: Science-Based Medicine

An announcement: I’ll be joining the Science-Based Medicine team of bloggers. I’m pretty excited. The Science-Based Pharmacy blog was inspired by the work of Drs. Gorski and Novella, who founded the SBM blog, and I’m honoured to be invited to contribute. Science-Based Medicine is the leading blog about science, medicine, and pseudoscience, and there’s a superb group of bloggers on the team. All of the contributors to SBM are fantastic, and several have their own personal blogs, too. I strongly recommend you follow Dr. Peter Lipson’s White Coat Underground, Abel Pharmboy’s Terra Sigillata, and Dr. Mark Crislip’s Quackcast podcast, in addition to SBM.

Science-Based Pharmacy isn’t going anywhere – it’s going to continue to be my primary blogging location. And there’s lots to talk about in the pharmacy profession. Coming up very soon: vitamins in the pharmacy.

Pharmacists, Pharmacies, Homeopathy, and Ethics

Is it ethical for a pharmacist to knowingly sell a mislabeled product – one that contains no active ingredient, and has been demonstrated to be no more effective than a placebo? That’s the question being asked by Dr. Chris MacDonald over at the Business Ethics blog today:

If someone selling something believes that it doesn’t work, should they tell you so? Does it matter if the person doing the selling is a licensed professional, someone with advanced training and a sworn duty to promote the public good?

Dr. MacDonald is referring to the fallout from the UK Parliament’s Science and Technology Committee Evidence Check on Homeopathy, which I’ve blogged about previously. As I pointed out in yesterday’s post, the regulatory body for pharmacists in Northern Ireland is acting on this report, and has proposed that patients be told that homeopathic products do not work, other than having a placebo effect. Continue reading