Posts Tagged ‘ Homeopathy ’

Complexity and Health – A Rant


To shamelessly butcher a great H2G2 quote:

Biology is complicated. Really complicated. You just won’t believe how vastly hugely mindbogglingly complicated it is. I mean you may think it’s complicated to do the morning crossword, but that’s just peanuts to biology.

This may seem trivially obvious, I mean we don’t compare things to brain surgery because brains are simple. But it always seems to me that the attraction of pseudo-science and altmed modalities occurs because of our yearning for easy answers. While proponents of alternative medicine affect superiority while berating conventional medicine for only treating symptoms not underlying problems it is their own philosophy that is childlike in it’s simplicity. In addition those in the altmed camp are sometimes embarrassingly binary in their approach to medicine, either vaccines work or they don’t, they are 100% safe or toxic, science is completely trustworthy or completely corrupt.

Take homeopathy*,while conventional science based medicine determines physiology, observes interactions, makes hypotheses and tests interventions and performs statistical analyses homeopathy stagnates. One of the fundamental precepts of homeopathy, the notion of “like cures like” is the most simplistic of magical thinking. Take a substance that causes a symptom in large doses and give it to a person suffering that symptom (from what ever cause, so much for treating underlying issues) in small doses and it is supposed to cure that symptom. Sympathetic magic as it has been called.

Speaking of magic, the Natural Health Expo is once again in town this month. browsing through the exhibitor list is like stepping through the looking glass. At the other end of those links are places were the rules** of the normal world do not apply, the laws of physics are suspended and anything is possible.

The breadth of inanity is so great that it’s hard to know where to start, so I just clicked on the first exhibitor and saw where it took me. African Gems and Minerals, seems solid, what could be on a firmer foundation than rocks from the earth?

Well, until you get to the page on crystals. Now I have to admit a certain fondness for crystals, the interesting variety of shapes and sizes, the symmetry and range of colours is captivating. What bugs me is the mystical properties attributed to them and the bizzare claims made for their properties, don’t trust me here’s a selection taken directly from the website:

“Kunzite Healing Stones Removes obstacles from one‘s path. It dissolves negativity automatically raising the vibrations of the area surrounding  it. Removes physical and spiritual blockages. Powerful sinus cleanser.  Use on the third eye for spiritual shift.”

Vicks has nothing on this rock, soothes the soul and clears the nose. And it sounds vaguely naughty – a must have.

“Serpentine Healing Stones. Light green is known as infinite stone… Enables one to enjoy each moment and to awaken to the inner knowledge which is so patiently  awaiting access. Excellent for easing pain. “

Opens the mind, and lets your brain fall right out. Good for aches and pains too.

“Peridot Healing Stones – Traditionally known as a stone that wards off evil. Regulates cycles of life: Physical Mental Emotional Intellectual as well as life cycles. Excellent healing stone and acts as a tonic to strengthen and regenerate the body. Birthstone for August. We have small rough stones and jewellery”

Strengthens and regenerates, well that’s vague. Will it help regenerate my dad’s hair?

“Rutile Quartz Healing Stones – Also called Angel Hair. Smokey with Rutile is a superior grounding stone that eliminates negativity promotes upliftment and joy and lifts depression. Banishes bad dreams. Strengthens the energy field. Counters electro-magnetic smog and radiation for example from computers. Rutile acts as an accelerator and speeds up the process while anchoring light into the physical being.”

Electromagnetic Smog, that sounds serious***. I’m curious exactly how this works, as electromagnetic fields are a three dimensional phenomenon how exactly does a lump of rock on your desk help you? I’m obviously over thinking it, that’s dangerous in these circles. Still “anchoring light into the physical being” sound handy, does that mean I won’t need a torch at night?

“Moldavite Healing Stones – Green Tektite found in the Molda Valley Russia. Supreme transformation stone. Activator of the third eye and heart chakra. Decodes the light body causing vibrational shift. This is sometimes experienced as the ”Moldavite Rush”. Best used in the guidance of a practitioner. A complete book was written about this stone “‘Moldavite – Star born stone of transformation‘”

Ah, the stone for professionals. Is this the one rock to rule them all perhaps?

In case you thing I looked around to the wackiest thing I could find to put up here, I assure you I didn’t. I had a clue what I was in for when the exhibitor description mentioned crystals but there was no other outward appearance of kookiness. This site displays no more and certainly less insanity than probably 80% of the other exhibitors listed****. Some further examples: Healing with cards(and reiki, and crystals), oh look a homeopath, Power Animal cards (and oddly, reiki again), not entirely sure what the heck this is.

For any of these things to work large swathes of known science would have to be wrong. I just don’t see the massive amount of evidence that would be required to show that this is true. On the other hand some of the claims are just so nonsensical  it’s difficult to even know what is being asserted let alone how one might go about confirming or refuting it. Still, good for a laugh eh?*****.

—-

*Actually don’t.

**Especially rules of evidence.

*** Probably worth a post of it’s own.

****The craziness is confined to one portion of their website whereas the rest are devoted to it.

***** Just to be clear, it is the claims of the proponents that are amusing and worthy of ridicule, not the unfortunate people who are drawn into these claims. That is most definitely NOT funny.

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2010
10/14
CATEGORY
Alternative medicine
Medicine
Psychological
Questionable Techniques
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3 comments

Pharmacy Customers Perception of Complementary and Alternative Medicine in Pharmacies


Going through the papers cluttering my inbox I found this survey of Australian pharmacy customers relating to their use of CAM and their impressions of how pharmacists should approach the subject.

Regular readers of Sciblogs may remember a kerfuffle earlier in the year regarding the sale of homeopathic remedies in pharmacies, I and others were uncomfortable with these items being sold in pharmacies to begin with. Fortunately, when surveyed homeopathy didn’t make it into the top ten modalities used in the last 12 months, though 3% noted that they had seen a homeopath.

This survey was published in BioMed Central‘s journal of Complementary and Alternative Medicine. I might point out that I disagree with the authors views of Complementary Medicine (CM) but I agree with many of the conclusions of the survey, though I suspect for different reasons.

The survey included data from 1,221 respondents from 54 pharmacies that cover both rural and urban areas. Beyond that the methods aren’t particularly interesting, people filled out forms.

Findings of the survey showed that a significant number of pharmacy customers think that it is important for pharmacists to be knowledgeable about CM and to know about their customer’s CM use. I would agree with this, pharmacists should be aware of how CM is marketed and of the claims made on order to give customers appropriate advice on effectiveness. Another result of the survey that helps with this point is that almost 70% of respondents agreed that they trust their pharmacist’s advice regarding CM. This reveals an excellent opportunity for education of the public regarding these modalities.

In addition many of the respondent felt comfortable telling pharmacist about their CM use whereas previous research has shown this not to be the case for patients of other medical practitioners. Again this is an opportunity for pharmacists to assess the safety of CM modalities their patients are using, especial in conjunction with other treatments (this was also a conclusion of the survey).

That said, the survey also revealed that many customers rely on family and friends as information sources. This accords with with existing research on the importance of personal anecdote in making decisions. Next most popular were medical doctors (not bad) and in third place (disturbingly) was the media. Pharmacists were in 6th place after naturopaths and pharmacy assistants. While far down on the list pharmacists still rank and one of the important sources of information and should not be under estimated.

One of the questions that I disagree with the majority of respondents on is regarding the inclusion of natural medicine practitioners in pharmacy practices. To me this is inviting abuse of the pharmacist’s position of authority, it might even undermine some customers trust of the institution (I’d certainly think twice about any pharmacy that did this). At the very least it may allow pharmacists to divest themselves of the responsibility to actually learn about the alternative products they may be selling.

In conclusion, I consider the results of this survey important to keep in mind when considering the role of pharmacists in the field of CM. Pharmacists are in a somewhat unique position to educate the public regarding CM as a consequence of the level of trust afforded to them by customers. It also reveals that pharmacies are vulnerable to particular abuse for exactly the same reason, products sold in pharmacies are lent an aura of respectability by association.

It behoves pharmacists to take seriously the responsibility to be current on the debate around the safety and efficacy of CM modalities and be able to confidently relay this information to customers. No longer should pharmacists sit on the sidelines while irrationality invades their practice, hiding behind public demand as an excuse for not taking a stand for science based therapies.

–
Braun, L., Tiralongo, E., Wilkinson, J., Spitzer, O., Bailey, M., Poole, S., & Dooley, M. (2010). Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice BMC Complementary and Alternative Medicine, 10 (1) DOI: 10.1186/1472-6882-10-38

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2010
08/05
CATEGORY
Alternative medicine
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World Homeopathy Awareness


Just when I thought I wouldn’t have to worry about Homeopathy again any-time soon I discover that next week (April 10-16) is World Homeopathy Awareness Week. In theory I am right behind an initiative such as this as homeopaths do a surprisingly poor job of educating the public about what homeopathy actually is.

I suspect though that highlighting the fact that there is no active ingredient in most homeopathic preparations and that huge swathes of established science would have to be wrong for it to work will not feature prominently in the promotional materials.

For those not in the know homeopathy is based on two principles not found anywhere in science, like cures like, known as the “Law of Similars” and less is more or the “Law of Infinitesimals”. In a nutshell these two “Laws” state that a substance that causes similar symptoms to a disease will cure it and the more you dilute the substance the more powerful it becomes. In practice this means that homeopathic preparations can have some unusual starting ingredients (like duck liver) and are diluted to the point that no active ingredient is left in the final product.

A common dilution for preparations is 30C, or 30 consecutive 100 fold dilutions. At this level not only are the no molecules of active ingredient left there aren’t even any molecules of water left from the last dilution that contained any active ingredient.

Due to this fact homeopaths have been reduced to very fanciful explanations of how it might work, most involves invoking some sort of water “memory” effect. This isn’t impossible but neglects to mentions that if it is the case, then the water also remembers every poison it has come into contact with as well. How does it know which effect it should have? Should it kill or cure?

A study performed in 2008 and published in the New Zealand Medical Journal showed that while 85% of respondents believed they knew what homeopathy was less than 5% knew that there is no active ingredient in most preparations. I don’t expect this statistic to change due to any efforts on the part of homeopaths or those that sell generic remedies.

Here’s a pithy website dedicated to How Homeopathy Works.

For those with a high tolerance to brain melting gibberish here’s a video with one of the more confusing explanations of homeopathy:
Youtube Page direct

[UPDATE: Thanks to commenter Lizditz on Dr Steven Novella's blog about this I have been alerted to this great philosophy paper on Homeopathy; "Evidence and simplicity: Why we should reject homeopathy", go read it now.]

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2010
04/09
CATEGORY
Alternative medicine
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New Zealand Pharmacy Ethics in Relation to Homeopathy in the Wake of Homeopathy Report


Earlier this year I wrote a post (along with fellow Sciblogger Grant) concerning the sale of homeopathic remedies in pharmacies. Monday night saw the release of England’s Science and Technology Committee’s “Evidence Check 2″ report on Homeopathy (also ably covered by Grant). One of the issues covered by the report is that of pharmacy responsibilities regarding sale of these remedies. Essentially the report recommended that sales continue but with adequate disclaimers stating that there is no scientific evidence that homeopathic products work beyond the placebo effect.

I see this as a compromise between commercial freedom to sell safe, though not necessarily effective, products and patient informed consent. It’s reasonable even if I disagree that it is ideal. Regardless, I thought it was a good excuse to look once again at our own pharmacies and see how the selling of scientifically unsupported remedies aligns with their professional responsibilities.

Enquiring into this area I was directed to the Pharmacy Council Code of Ethics for pharmacists. The Pharmacy Council seems to fill the function of professional association and regulatory body for pharmacists their functions including:

prescribe the qualifications required for scopes of practice within the profession, and, for that purpose, to accredit and monitor educational institutions and degrees, courses of studies, or programmes

and

consider the cases of health practitioners who may be unable to perform the functions required for the practice of the profession

Perusing the Code of Ethics (which may be found Here) I found a number of sections that I feel should preclude pharmacists from selling homeopathic remedies in good conscience. In order to try and represent the spirit of the code as accurately as possible I have included here both the relevant over-arching Principles that pharmacists should strive for as well as the Specific Obligations that I feel make my point (any emphases are mine).

The first principle is one of patient autonomy:

Principle 1: Autonomy
The pharmacist shall promote patient
self-determination, respecting the
patient’s right to understandable
information, privacy, and confidentiality

1.4 Professional services
Where the patient is seeking or receiving, from the
pharmacist or from other personnel for whom he or
she has responsibility, any professional service or
intervention, the pharmacist must ensure that the
patient is provided with credible, understandable
information about reasonably expected results,
outcomes or effects of the service or intervention, any
risks of receiving the service or intervention, and any
insufficiency of evidence about the efficacy of the
service or intervention, to allow the patient to make
an informed choice.

This to my reading implies that should pharmacists sell homeopathic remedies they are obligated to inform the patient of the lack of scientific underpinnings for the use of the remedy. One of the objections I have run into regarding the sale of these remedies in pharmacies is that they are commercial enterprises and are within their rights to sell products regardless of their medicinal value. This is partially true but these remedies are specifically sold to treat symptoms, not as entertainment, confection or cosmetic. The Code has several entries covering this aspect the first of which is:

1.5 Independent information
The pharmacist must ensure that their advice is
independent of personal commercial considerations.

Does this not imply that the sale of unscientific medicines should not be undertaken simply because it make financial sense? We will return to this point later.

The next Principle covers patient needs:

Principle 2: Beneficence
The pharmacist shall optimise medicines
related health outcomes for the patient
according to their concerns, needs,
cultural values and beliefs

2.2 Quality use of medicines
The pharmacist must provide scientifically-based,
unbiased medicines information to healthcare
providers, patients and the community in order to
optimise medicines related health outcomes.

My reading of this point leads me to understand that any information provided regarding pharmacy products must have scientific backing and moreover must not be biased by the pharmacist’s own views. Any such information regarding homeopathy must therefore be negative.

But, what if the pharmacist is not asked for this information? After all, I do not usually go in asking for a lecture if I already think I know what I need. I think the next obligation covers this instance:

2.8 Involvement in sale of medicines and other
therapies
The pharmacist must be involved and intervene in the
sale of any medicine, complementary therapy, herbal
remedy or other healthcare product whenever this is
necessary to ensure a reasonable standard of
pharmaceutical care.

Scientifically speaking homeopathy should not be considered to encompass a “reasonable standard of pharmaceutical care”.

The next Principle of relevance concerns fairness:

Principle 4: Justice
The pharmacist shall practise fairly and
justly and promote family, whanau and
community health

4.4 Commercial interests not to override good
practice
The pharmacist must ensure that commercial interests
are not permitted either to override the independent
exercise of their own professional judgement on
behalf of a patient or to compromise the standard of
care provided by them or to affect their cooperation
with other healthcare providers.

Once again the issue of financial gain over patient care is addressed with commercial interests coming off second best when the standard of care is concerned.

The next Principle is one I feel is of especial importance when the reputation of pharmacists in the wider community is considered and their self representation in the media is a factor (remember, they’re the health professional you see most often). This is trustworthiness, pharmacists are seen as, and promote themselves as, first and foremost medical professionals not business interests. The sale of homeopathic medicines is antithetical to this position and undermines their credibility in this regard, in direct contraction to the Code of Ethics as follows:

Principle 7: Trustworthiness
The pharmacist shall act in a manner
that promotes public trust in the
knowledge and ability of pharmacists
and enhances the reputation of the
profession

7.7 Non-medical goods and services
The pharmacist must not purchase or sell from a
pharmacy any product or service which may be
detrimental to the good standing of the profession or bring the profession into disrepute.

If the sale of scientifically worthless remedies such as homeopthy does not do this I don’t know what would, perhaps offering Therapeutic Touch?

Finally the Principle of dignity undermines the pharmacist’s sale of unsupported medicines:

Principle 8: Dignity
The pharmacist shall provide
information about professional services,
medicines and healthcare products in a
dignified manner without making
exaggerated or unsubstantiated claims

8.4 Medicines not ordinary articles of
commerce
A pharmacist must only participate in promotional
methods that do not encourage the public to equate
medicines with ordinary articles of commerce.

If the previous examples of why remedies should not be sold with the sole purpose of earning money for the pharmacist this should put that argument to rest. The sale of medicines (which many people consider homeopathy to be) should not be equated with ordinary articles of commerce. This puts the lie to arguing that these remedies are simply another commodity to be bought and sold like chewing gum regardless of therapeutic value.

8.8 Evidence of efficacy
The pharmacist must only promote to a potential
purchaser that any medicine, complementary therapy,
herbal remedy or other healthcare product associated
with the maintenance of health is efficacious when
there is credible evidence of efficacy.

This last obligation explicitly refers to promotion of a therapy to a patient by the pharmacist which I don’t think any reputable pharmacist would do for homeopathy but arguably the presence of the product in the store constitutes an implicit promotion of it to potential customers. This point goes back to the principle of trustworthiness, the public trusts the pharmacist to stock efficacious products. To include unscientific therapies among their wares undermines and betrays this trust. Perhaps I am naive to think so but I think the Pharmacy Council’s own Code of Ethics backs me up when I say that we should hold pharmacists to a higher standard than your average shop owner.

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2010
02/24
CATEGORY
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4 comments

What is the Harm of Alternative Medicine?


Yesterday fellow Sciblogger Grant posted about homeopathic medications in pharmacies and questioned the legitimacy of reputable organisations selling such patent snake oil. The comments to this entry reveal one of the most frustrating aspects of speaking out against unscientific medicine and can be summarised thusly: “I’m far too sophisticated to be taken in by this stuff myself but other people seem to like it and if it doesn’t work then what’s the harm?”.

This attitude is ever present and comes from a reasonable starting point i.e. everyone is entitled to their own opinion and it’s not my job to save them from themselves. I can totally get behind that, usually. When it comes to ineffective medications of the alternative variety however this impulse though understandable is misguided and I’d like to put down a few reasons why I think so, some are speculative but I think the possibility of harm is great enough that they deserve to be considered.

For a start there may well be direct harm caused by using alternative remedies. As there is little to no regulation of these medications then no proof of safety or efficacy is required for sale. Witness the Zicam debacle last year regarding a “homeopathic” cold medication.

Further more the possibility for indirect harm (as multiply alluded to by Grant) may be significant. In case your imagination is not up to the task I will outline a few ways this may be the case. For instance the underlying principles of something like homeopathy are no only unscientific they are in direct contradiction of the last 200 years of scientific understanding. If they are used as the basis of reasoning about health then the results can be more dire than someone getting a bad nights sleep (in the case of the homeopathic sleep aid Grant used as an example).

Use of these therapies for minor ailments by the “worried and wonky well” may increase the possibility they they will be used for more serious health issues where the results could be deadly.

Look no further than the position statement of the WHO regarding the use of homeopathy in the treatment of Malaria and AIDs (among other things). The consequences of such thinking could be incalculable in terms of human suffering and spread of disease. But what’s the harm, right?

Additionally it is one thing for adults to make an informed choice for themselves based on available evidence filter through their particular world view but what about when this choice id forced on their children? The recent case of parents being found guilty of manslaughter over giving homeopathic remedies to their sick daughter is a terrible reminder that sometimes it is innocent children that pay the price for people’s gullibility. But, you know, what’s the harm?

When ostensibly professional medical providers such as pharmacists sell demonstrably irrational treatments they lend credibility to them that the average person uses to base decisions on. I mean the wouldn’t sell it if it didn’t work, right?

So while I understand the commitment to individual autonomy and freedom of choice that leads to the “What’s the Harm?” question, I fail to see how this means that fraudulent therapies must be let off the hook simply because there is a demand for them.

This has been a more vitriolic post than I normally write but what’s the point of a blog if you can’t vent once in a while?

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2010
01/26
CATEGORY
Alternative medicine
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12 comments

Allopathy


Allopathy is a term that was coined by homeopath Samuel Hahnemann (1755-1843). The word is used primarily by alternative medicine proponents to describe the methods of the science based medical establishment. In this way they can differentiate themselves from mainstream doctors without admitting that the main difference is the reliance of “Western” medicine on evidence and experiment instead of tradition and ideology. So called allopathic medicine is criticized as not being holistic and treating symptoms instead of patients.

How exactly this differs from altmed is unclear but it is in fact quite untrue, a good doctor will take a case history by asking relevant questions and will tailor treatments to suit taking allergies, severity of condition and increasingly even ethnicity into account. Despite what altmed practitioners would espouse modern medicine is not a cookie cutter one size fits all enterprise. The work of scientific medicine is continual to fine tune therapies and create new and better ways to improve health based on basic research and the open exchange and debate of ideas. This is in contrast to many so called alternative practices which are dogmatic and may have changed little in hundreds of years, which for some reason is touted as a good thing.

The strength of science is that it is constantly being added to, refined and revised. When something is found to be incorrect or inferior then it can be discarded or revised to always come closer and closer to the truth. Some point to this and proclaim it as a weakness that scientific knowledge is always tentative and subject to change. The response of the rational, reasonable and scientific to this charge is a resounding YES, we may be wrong, but we are at least searching for the answers.

Resources

http://www.skepdic.com/allopathy.html

http://www.ncahf.org/articles/a-b/allopathy.html

http://www.quackwatch.org/01QuackeryRelatedTopics/OTA/ota14t.html

2008
01/11
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Alternative medicine
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Homeopathy


Earlier this year I took a trip to India, Goa to be precise. Though this fact is only of tangental interest, the real reason for this entry is the fact that before we headed out, one of my sister in law’s friends recommended a homeopathic remedy for jet lag, creatively called “No Jet-Lag”. My wife, thinking this was a great idea- Jetlag is a drag-, purchased the product and brought it home. Curious about the item I looked at the active ingredients, there were about five herbs listed as active ingredients listed and next to each there was written 30C.

Here’s where the trouble starts. This little unobtrusive inclusion means that the active ingredient is diluted by a factor of one hundred 30 successive times. “So what” you might be thinking, “molecules are tiny”. You would of course be correct in the second part. But lets see what happens to something when diluted this much. In one mole of substance there are 6.0221415 × 1023 molecules(For water this correlates to 18g).

To help illustrate the point I’ll write that out with all the zeroes, but instead of the usual commas after every three zeroes I’ll put numbers representing each successive dilution that will show how many molecules are left : 6011221014915800700600500400300200100 .


You can see that after the 11th dilution only 60 molecules remain and we aren’t even at the half way mark. So it’s easy to see that at 30C, your chances of finding even a single sub atomic particle of the original substance is slim to say the least. I recommend doing the calculations to see what volume of water you would need to carry out the dilution in a single step starting with 1mL. I tried but gave up when I got to 1 million cubic kilometres.

The “No Jetlag” Website:

http://www.nojetlag.com/

2007
10/01
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Alternative medicine
Medicine
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