Medical history is full of strange practices and beliefs. As scientific principles have become the framework for determining what works (and what doesn’t) in medicine, we’ve seen a steady progression towards more science-based, evidence-based care. Yet some unscientific practices still exist, even when we know they don’t work. It might surprise you to learn that some people believe sugar pills can prevent and heal disease. This belief system, called homeopathy, is a multi-billion dollar industry worldwide, and it’s growing. While there is no convincing evidence to demonstrate that homeopathic treatments are more effective than a placebo, many consumers and even some health professionals accept homeopathy as a legitimate health treatment, and its providers as legitimate health professionals.
Responding to the perceived consumer demand for these products, government regulators have had a difficult decision to make: They could ignore homeopathy as a health practice, treating it like we might think of astrology: firmly outside of medicine, and for entertainment purposes only. Or they could choose some form of regulation, targeting the providers (homeopaths) or the product (homeopathy), possibly with the goal of managing its use, or perhaps limiting harms to consumers. The risk of regulating nonsense is the perceived legitimacy that recognition and regulation implies. Regrettably, regulation in many countries has had that exact effect. What’s worse, regulation often seems to have prioritized the commercial interests of homeopaths (and manufacturers) over the public interest, leaving consumers with little understanding that homeopathy lacks any scientific credibility.
Given the lack of scientific credibility and the evidence it offers no medical benefit, homeopathy has attracted increasing criticism from health professionals, scientists, and science journalists over the years. This advocacy appears to be having an effect. Regular readers at the Science-Based Medicine blog will recall several posts over the past few weeks, describing the possibility of new regulation of homeopathy by the US Food and Drug Administration (FDA). And just recently, Health Canada announced two important changes to its homeopathy regulation, which may signal a new direction that prioritizes the consumer interest and public health. Are we witnessing the beginning of more sensible regulation of this prescientific practice? Continue reading
Can you spot the sugar pills among the medicine?
Retail pharmacies have a sugar pill problem. Homeopathic “remedies” look like conventional medicine when they’re stocked on pharmacy shelves, like the photo above. But unlike conventional medicine, homeopathic products don’t contain any “medicine” at all. They are effectively and sometimes literally sugar pills – placebos. Not surprisingly, there is convincing evidence to show that homeopathy is useless as a medical treatment, and fundamentally incompatible with a scientific understanding of medicine, biochemistry and even physics. Questions have been raised worldwide about the ethics of pharmacists and pharmacies selling homeopathy to consumers who may not realize what they’re buying. This practice, which appears to be growing, is attracting sharp criticism from other health professions. So why do pharmacies sell them? And will the pharmacy profession change? Continue reading
New warning labels on anti-inflammatory drugs highlight this risks associated with these drugs.
Owing to summer vacation, today’s post updates a 2011 post and a 2013 post with some new information.
Anti-inflammatory drugs are among the most well-loved products in the modern medicine cabinet. They can provide good pain control, reduce inflammation, and eliminate fever. We give non-steroidal anti-inflammatory drugs (NSAIDs) in infancy, continuing through childhood and then adulthood for the aches and pains of modern living. It’s the later stages of life where NSAIDs are used most frequently, usually in the treatment of joint disease like osteoarthritis, which eventually affects pretty much everyone. Over 17 million Americans use NSAIDs on a daily basis, and this number will grow as the population ages. While they’re widely used, they also have a long list of side effects. Not only can they cause stomach ulcers and bleeding by damaging the lining of the gastrointestinal tract, the cardiovascular risks are real and significant.
It was the arrival (and withdrawal) of the drugs Bextra (valdecoxib) and Vioxx (rofecoxib) that led to a much better understanding of the potential for these drugs to increase the risks of heart attacks and strokes. And it’s now well-documented that these effects are not limited to the “COX-2″ drugs – almost all NSAIDs, including the old standbys we have used for years, raise the risk of heart attacks and strokes. Given how frequently these products are used, it’s essential that pharmacists and their patients understand the risks in order to make informed decisions based on expected benefits and known risks. Continue reading
Our diet is either the cause of, or solution to, all of life’s problems. I’m paraphrasing a great philosopher. We just can’t seem to let food be food today. Each ingredient we eat must be obsessed over, then either demonized or glorified. Gluten is the latest evil. It used to be fat. At some point in the past, it was MSG. If it’s not evil, it’s a superfood, preferably local, organic and GMO-free. But even on the healthiest diet, however, we’re apparently still ingesting too many harmful “chemicals”. Gwyneth Paltrow says so. So does the Food Babe. In an era of daily television quackery and loony internet health conspiracy websites, one might think that bizarre food ideas are a recent phenomena. But worries that we’re being poisoned from within are probably innate. One of the oldest surviving written documents is an Egyptian papyrus from the 16th century BCE that linked the cause of disease to digestive wastes in our colon. Since that time, our scientific knowledge about the cause of disease has advanced, but the underlying obsession with diet and elimination hasn’t waned. Anecdotally, it seems to be growing. Orthorexia nervosa was a term first described in 1997, reflecting obsessive eating beliefs and habits. The idea that our bodies need to “detox” is thriving, despite the fact that it has no scientific basis or validity. Part of the modern appeal of “detox” may be that detoxification is a legitimate medical term and treatment. However, in the alternative-to-health perspective, the word has been co-opted, but the science part has been ignored. Fake “detox” is easy. And now proponents of “detox” have taken it one step further. They’re using real medicine for a fake “detox” with. That’s how activated charcoal has become the latest health fad. It’s another symptom of the misguided beliefs about what’s thought to be “healthy” eating. Continue reading
A pharmacist discusses medications with a patient.
I’m a health professional, but sometimes a patient as well. And like most patients, I generally don’t want health decisions being made without my input. Yes, I want the best medical information, and the advice of medical professionals, but ultimately I want to make my own decisions about my care. That’s the norm in health care today, but relatively new in the history of medicine.
Medical paternalism, where patient preferences are secondary (or even ignored), is disappearing. Even informed consent, where patients are given information on risks and benefits, doesn’t adequately describe the drive towards a two-way exchange, with an empowered, engaged patient. Today the goal is shared decision making, which describes a mutual decision that is informed by a health professional’s medical knowledge and advice, but also incorporates a patient’s own preferences and wishes. Truly shared decision-making includes an explicit consideration of a treatment’s expected benefits and potential harms, yet reflects patient values.
Screening is a textbook example of why shared decision-making should be our goal. Given the benefits of a disease screening program may be modest, and not without harms, understanding and incorporating individual preference is essential. Some may value the small but incremental benefits of screening, and choose to be screened despite the risks of false positives, investigations, and possible overtreatment. Given the exact same circumstances, another individual may opt to forgo screening, making a different, yet equally acceptable decision. While there are some health interventions for which the benefits are unequivocal, and others for which the harms are just as clear, most health treatments (and interventions like screening) have both benefits and potential harms that must be carefully assessed within the context of patient preferences. Research published earlier this year has identified a significant barrier to truly effective shared decision-making and risk assessment: Across a wide range of interventions, we routinely overestimate the benefits of health treatments, and underestimate their risks. Continue reading
Nothing is better than Nighton
Like many Canadians who saw last week’s news article “Health Canada licensing of natural remedies ‘a joke,’ doctor says” in the lead-up to Friday’s Marketplace episode on CBC, I was very interested in learning the story behind it. Unlike many Canadians, I wasn’t at all shocked or surprised by the outcome. This blog (and others) have been critical for years about the lack of oversight where the Natural Health Products Directorate (NHPD) is concerned. (The NHPD recently changed its name to the Natural and Non-prescription Health Products Directorate. (NNHPD)) See “Do the Natural Health Products Regulations Benefit Canadians?”, “Health Canada Gets Out a Big Rubber Stamp” & “Safe and Effective? A Consumer’s Guide to Natural Health Products” for some background. For those who haven’t had a chance to view the episode, it can be viewed here: Continue reading
Is what’s on the label actually in the capsule?
Most of us are fortunate to live in countries where we don’t have to worry about counterfeit drugs. We can be confident that the prescriptions we receive, or the drugs we purchase from the pharmacy, are of high quality and contain exactly what’s on the label. But in these same countries, there’s another group of products where the risks of counterfeits are very real – it’s among the dietary supplements that are often found on the same shelves. Dietary supplements are not regulated in the same way as drug products. The American supplement industry is a multi-billion dollar free-for-all with little meaningful safety or quality regulation. Supplement quality and safety issues are in the media regularly as a result. The most recent example comes from the New York State attorney general’s (AG) office. It has accused four large retailers of selling supplements that failed to contain labelled ingredients. Testing the products with a technology called “DNA barcoding”, the AG’s office concluded that most of the products contained little to none of the labelled ingredient. And they also found ingredients that were not disclosed on the label. The AG’s office has demanded these products be removed from store shelves, and the stores stand accused of fraud. Continue reading
Last Thursday, the Toronto Star ran a front-page story on the Gardasil vaccine, describing the vaccine as having a “dark side”: debilitating illnesses. The headline and the story describe a supposed relationship between the vaccine and an array of serious adverse events:
What was the basis for the Star’s claim that the vaccine causes harm, and that risks are not being disclosed? The story primarily focused on interviews with women and their families who attribute different events to the vaccine. The Star went on to analyze Health Canada’s database and claims it found 50 “serious” incidents, including 15 hospitalizations. Studying the US adverse event database, the Star reported it found thousands of cases of harm, including more than 100 deaths. The implication the Star makes is clear: Harms and risks are not being disclosed to vaccine recipients. Yet while the cases the Star reviews are tragic and in some cases heartbreaking, the relationship to the vaccine is not established in any of the cases it profiles. A single sentence acknowledged the lack of actual evidence linking the vaccine to any of the adverse events it describes:
In the cases discussed in this article, it is the opinion of a patient or doctor that a particular drug has caused a side-effect. There is no conclusive evidence showing the vaccine caused a death or illness.
Relying heavily on anecdote instead of objective scientific evidence, The Star implies causation when all it could show is correlation. The result was a classic “false balance” picture painted about the HPV vaccine’s safety – a gift to the anti-vaccine movement, which also relies heavily on anecdotes and emotion, rather than scientific facts. False balance is always a fear with vaccine reporting, particularly because “false balance” propagates unfounded fears, implying a scientific “debate” when the consensus says otherwise. Given viewing anti-vaccine messaging for a even few minutes can decrease intentions to vaccinate, it is essential, from a public health perspective, to communicate vaccine safety information responsibly. But that didn’t happen with the Star’s vaccine story. From the headline through the reporting, the story failed to communicate risk and benefit effectively. This is unfortunate, because the the HPV vaccine has been studied – extensively. There is robust, high-quality data that establishes its safety. And the Star presented no evidence to demonstrate that the harms of the vaccine have been misstated. Continue reading
I thought I’d written my final post on the Dr. Oz-fueled green coffee bean extract (GCBE) diet supplement fad. But now there’s another appalling chapter, one that documents just how much contempt The Dr. Oz Show seems to show for its audience, and how little Dr. Mehmet Oz seems to care about providing medical advice that is based on good science. Last week it was revealed that the “naturopath” that Dr. Oz originally featured in his GCBE segment, Lindsey Duncan, didn’t disclose a direct conflict of interest when he spoke. After inaccurately describing the supplement’s effectiveness, he directed consumers, using keywords, to web sites that he owned or operated. The infamous “Dr. Oz Effect” worked, with Duncan selling $50 million in GCBE supplements in the following months and years. It has also been announced that Duncan and his companies have been fined $9 million by the Federal Trade Commission (FTC). The documentation released by the FTC [PDF] gives remarkable insight into how a scam to make millions was launched, and how the Dr. Oz Show is a willing platform for the routine promotion of dubious “experts” and worthless supplements. Continue reading
Alternative medicine is ascendant in Canada. From the dubious remedies that are now stocked by nearly every pharmacy, to the questionable “integrative” medicine at universities, there’s a serious move to embrace treatments and practices that are not backed by credible evidence. Canada’s support for alternative medicine, and for its “integration” into conventional health care is arguably is worse than many other countries. Canada’s drugs regulator, Health Canada, has approved hundreds of varieties of sugar pills and declared them to be “safe and effective” homeopathic remedies. Some provinces are even moving to regulate homeopaths as health professionals, just like physicians, nurses and pharmacists. Given the regulatory and legislative “veneer of legitimacy” that homeopathy is being granted, you can see how consumers might be led to believe that homeopathic remedies are effective, or that homeopaths are capable of providing a form of health care. The reality is far uglier, and the consequences may be tragic. Canadian homeopaths are putting the most vulnerable in society at risk by selling sugar pills to consumers, while telling them that they’re getting protection from communicable diseases. Continue reading