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
My post on Mozi-Q from 2013 has drawn the attention of a new show called “Man vs Princess”. Join me (Sara) live on Friday, May 1st at 2:00 pm EST with hosts Luke Tipple and Aria Johnson.
Tweet your questions in advance using the hashtag #ManvsPrincess
You can watch the show live by following this link: https://www.youtube.com/watch?v=Iwo5TyinpBk, and it will also appear below:
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
I joined Professor Chris MacDonald at Ryerson University earlier this week to participate in Ryerson’s business ethics speaker series. The topic was CAM:
Is it ethical to market complementary and alternative medicines? Complementary and alternative medicines (CAM) are medical products and services outside the mainstream of medical practice. But they are not just medicines (or supposed medicines) offered and provided for the prevention and treatment of illness. They are also products and services – things offered for sale in the marketplace. Most discussion of the ethics of CAM has focused on bioethical issues – issues having to do with therapeutic value, and the relationship between patients and those purveyors of CAM. This presentation — by a philosopher and a pharmacist — aims instead to consider CAM from the perspective of commercial ethics. That is, we consider the ethics not of prescribing or administering CAM (activities most closely associated with health professionals) but the ethics of selling CAM.
You can watch it here here.
It was great to see so many public members attend and participate. There was an extended Q&A afterwards, with some very thoughtful audience questions. Watch for more on this topic from us in the future.
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
Sugar pills won’t protect you from Influenza – or anything else.
As pseudoscience goes, homeopathy takes the cake for absurdity. It is an elaborate placebo system, based on nonsensical ideas about biology, biochemistry and medicine. A decision to use homeopathy is a decision to do nothing at all, because homeopathic “remedies” have no medicinal ingredients in them at all. They are inert. Homeopathy is based on the idea that “like cures like” (which is simply a form of magical thinking) involving successive dilutions of products in water. The dilutions are believed to increase, not decrease, the potency of the final product. And these are serious dilutions. Think of putting one drop of a substance into a container of water. Only that container is 131 light-years in diameter. That’s the “30C” dilution used by homeopaths. Homeopaths believe that the water molecules retains a “memory” of the original substance (while conveniently forgetting all the other products it has come in contact with.) The final remedy is diluted so so completely that most “remedies” don’t contain a single molecule of the the original substance you started with.
A homeopathic nosode is a homepathic “remedy” made from infectious material. Unbelievably, Health Canada approves homeopathic “nosodes” for sale in Canada, despite a lack of any evidence they can do anything. Due to lobbying by groups like Bad Science Watch, Health Canada eventually agreed to force products to label nosodes with the caution “This product is not intended to be an alternative to vaccination”. While this was better that the status quo, there was the fear that homeopaths and other alternative health providers (like naturopaths) would continue to promote homeopathy to prevent or treat communicable disease. And the skeptics were right. Continue reading
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.