This weekend has seen the “10-23 challenge” occur, where science advocates worldwide are “overdosing” on homeopathic products, to demonstrate that they contain no active ingredients and have no therapeutic effects. This builds on last year’s event in the UK and Australia, which was a success: absolutely nothing happened to any participant. This year, overdoses have taken place across Canada and around the world. As part of the challenge, this weekend James Randi reiterated a promise to pay $1 million to anyone that can prove homeopathy works. Here’s some excerpts from that announcement, where he points to pharmacies as being part of the problem: Continue reading
Working in pharmacies where supplements are sold alongside traditional (over-the-counter) medications, I’m regularly astonished at the different perceptions consumers can have about the relative efficacy and safety of different types of products. Once, speaking with a customer about a medical condition she wanted to treat, I indicated that there were no effective non-prescription therapies — she needed to see a physician for access to an effective treatment by prescription — and I gestured behind the counter. “Back there?!” she pointed. “That’s where you keep the stuff that kills people! I want something natural!” Suggesting that my patients with heart disease or HIV had a somewhat different perspective, I tried (unsuccessfully) to talk her out of a questionable-looking supplement (Hint: avoid anything from a company with a P.O. box as a mailing address.) This appeal to nature, combined with a perception that natural products are safe, and conventional drugs are unsafe, is pervasive. Continue reading
One of my earliest lessons as a pharmacist working in the “real world” was that customers didn’t always act the way I expected. Parents of sick children frequently fell into this category — and the typical vignette went like this for me:
- Parent has determined that their child is sick, and needs some sort of over-the-counter medicine.
- Parent asks pharmacist for advice selecting a product from the dozens on the shelves.
- Pharmacist uses the opportunity to provide science-based advice, and assures parent that no drug therapy is necessary.
- Parent directly questions the validity of this advice, and may ask about the merits of a specific product they have already identified.
- Pharmacist explains efficacy and risk of the product, and provides general non-drug symptom management suggestions.
- Parent thanks pharmacist, selects product despite advice, and walks to the front of the store to pay.
In many ways, a pharmacy purchase mirrors the patient-physician interaction that ends with a prescription being written — it’s what feels like the logical end to the consultation, and without it, feels incomplete. It’s something that I’m observing more and more frequently when advising parents about cough and cold products for children.
As has been repeatedly pointed out on this blog, homeopathy is an elaborate placebo system, with most remedies diluted so greatly that not a single molecule of the original material remains. The final product sold to consumers is quite literally, water – drops of which are dried on sucrose or lactose tablets. The fact that homeopathy has not been shown to be more effective than placebo should surprise no-one: it is a placebo, and the positive effects reported are placebo effects.
Because there are no medicinal ingredients, there is no way to take a typical homeopathic remedy and, by testing it, determine which remedy it’s supposed to be. All you would find would be sugar. That’s why Health Canada doesn’t require any post-manufacturing quality testing of the remedies it deems “safe and effective” – there’s nothing that can be objectively measured. So whether it’s lead, rabbit vagina (really), or the liver and heart of a duck, once they’re diluted enough, there’s nothing to distinguish one homeopathic remedy from another. Yet each approved product is granted a unique license number by Health Canada.
Homeopathy’s lack of active ingredients gives the products a reasonable safety profile. After all, a product can’t cause side effects, if it doesn’t cause any effects at all. So you can take plutonium, dilute it enough, and you won’t get radiation poisoning. But when a homeopathic remedy isn’t diluted enough, you can be exposed to the initial substance, which can be toxic. Enter Hyland’s Teething Tablets, and a recent warning from Health Canada: Continue reading
The following is a summary of my Skepticamp Toronto 2010 presentation. Apologies to international readers for the Canadian-centric content.
I’ve been practicing pharmacy for over 15 years, and it didn’t take me long to realize after I started working that there was a completely different standard for safety and efficacy for herbal preparations and other supplements. That is, they were largely unregulated. Compared to Health Canada’s internationally-respected approval process for drug products, there was no process in place to regulate the supplement marketplace. To ensure consumers fully understood the potential risks of these products, I started to give two warnings to anyone that asked for my advice about these products:
Compared to drugs, there is little regulation of herbal products. Variation could exist between what it says on the label and what it actually contains.
And if they had any medical conditions, or were taking other drugs or supplements I would add:
Compared to prescription and over-the-counter drugs, the information we have on these products is limited. They could have the potential to interact with other medications and medical conditions that we are not aware of.
Until just a few years ago, Canada’s regulatory framework was not equipped to deal with non-drug supplements. Products were either drugs, and were registered as such, or they were food products, and drug regulatory requirements did not apply. A grey area existed and and all kinds of supplements appeared – with no specific regulatory oversight, no defined quality or content standards, and no objective evaluation of the efficacy claims. Continue reading
]I want to highlight a popular new recurring post over at Skeptic North: Health Canada Approves. Each week, Erik Davis describes two remedies: An actual product reviewed and approved by Health Canada’s Natural Health Products Directorate, and one that is completely made up. Based on his description (no googling!), can you identify which product is approved as “safe and effective”? The results are posted one week later, and Erik reviews the evidence that exists for the approved product. Given these products are found on pharmacy shelves, see if you can guess which is the “real” remedy.
How do Canadian regulations for natural health products compare to American regulations for dietary supplements? Which are superior, from a consumer protection perspective? Is either approach science-based? That’s the topic of my post today, over at Science-Based Medicine. Go check it out.
Canada’s regulatory framework for natural health products (NHPs) has undergone a prolonged, painful, implementation. And it doesn’t seem to be getting any better. The Natural Health Products Regulations were designed to provide Canadians with minimal assurances of product quality, safety, and efficacy, while recognizing that little high quality, objective evidence usually exists to substantiate efficacy claims. The results has been mixed. The regulations offer reasonable assurance of manufacturing quality and product safety, but it’s also led to the licensure of homeopathic remedies, some with specific “Recommended Uses” for what are indistinguishable sugar pills. At a minimum, however, the regulations should assure Canadian consumers that what is on the label is actually in the bottle. That’s a win. Plus, one of most important elements of the NHP regulations is the implementation of pre-marketing registration requirements. That is, only products reviewed and deemed to meet minimal standards of product quality, safety, and the (relaxed) standard for efficacy claims would be permitted to be sold as of 2010. Manufacturers were given six years to meet these requirements. Unfortunately, there’s a big backlog in the queue at Health Canada. About 12,000 products haven’t been reviewed yet. Continue reading
On Wednesday, Tom Blackwell in the National Post wrote about the reluctance of regulators to take action against misleading advertising from natural health product manufacturers. I’m quoted, and I brought up the point that Health Canada is complicit in misleading consumers, by assigning unique numbers, and treatment claims, for homeopathic sugar pills:
Scott Gavura, a Toronto pharmacist who operates the “science-based pharmacy” website, argued the problem is not just unlicensed natural-health products.
Many licensed products have won government endorsement based on flimsy evidence, he said, citing the many homeopathic medicine products that have been approved, despite ongoing debate about whether the heavily diluted substances actually do anything.
“We have indistinguishable sugar pills being assigned natural-health numbers,” he said.
I also spoke with Rob Breakenridge (AM 770, CHQR Calgary) on Friday, discussing the same issue. Rob’s got a great skeptically-minded show. If I can track down a recording of the interview, I’ll post it. Here’s a link to my interview with Rob.
Here’s the Post article: Tom Blackwell: Health ads misleading, watchdog says
It’s World Homeopathy Awareness Week. Today’s post is a deeper dive into the world of homeopathic “evidence”. Looking at the science, we’ll highlight the implications of regulators applying two sets of standard to health products: One for medicine, and one for homeopathy. Today’s post is a collaboration with Kim Hebert, who blogs at Science-Based Therapy.
The kindest that can be said about most homeopathic products is that they won’t cause adverse effects. After all, most common “strengths” or “potencies” used in homeopathy are so dilute there’s no possibility of a single molecule of the original substance remaining in the remedy. But what if, instead of diluting a product the typical 30 times, it’s only diluted once or twice? Is it still homeopathy? There’s a very good chance of some molecules of the original substance remaining. That’s the case with today’s case study, Traumeel. Continue reading