Empower Health: Week 1

So last week I noticed, with more than a little consternation, that the Vancouver Sun has begun publishing a feature it calls Empower Health:

Better health is not a destination. Your health is a journey of small steps, things you can do to improve your mental and physical well-being.

Empowered Health is a new locally produced television program that shows you the path to better health with weekly tips on eating better, improving your fitness and navigating the minefield of the health care system and the dozens of complementary and alternative therapies and practices.

Those of you who don’t know much about Vancouver aside from the excellent work that the Vancouver Skeptics do here may be unaware that it is a city full of woo-woo nonsense. One can’t walk a city block without stumbling over a reflexologist or a chiropractor or some other snake-oil peddler trying to separate fools from their money. Because Vancouver has a large population of young, well-educated and upwardly mobile people, it has succumbed to the stereotypical west-coast syndrome of buying wholesale into “alternative” practices. Add to that a large immigrant population bringing practices from their countries of origin and a well-developed sense of fascination with anything “exotic”, and you have a perfect recipe for this kind of hucksterism.

Now, ordinarily the only thing I read the Sun for is local news and Canucks coverage, but I figured I wouldn’t be doing my duty as a local skeptic if I didn’t take a swing at the glass jaw they’re dangling out there. So I will try, every week, to digest the claims made in these articles. [Read more...]

Health care by the numbers

Once again I feel the need to reiterate that my comments about health care are personal opinions only, and do not reflect anyone’s positions but my own.

Part of the reason I am so opposed to the private delivery of health care is that the market tends to work on a principle of caveat emptor – let the buyer beware. The problem with this generally-sound skeptical principle when it is applied to health care is that people are not “buyers” of health care, nor can they said to be “consumers” in the same way as someone walking into a hardware store or restaurant. A hefty proportion of our interactions with the health care system are in times of crisis, meaning that it is unreasonable to expect us to do the kind of cold, rational calculus that one might expect of someone choosing a realtor or a bottle of fine scotch.

Congruent with this issue of need-based service consumption is the incredibly high bar of education required to understand how the health care system works. Most people are capable of understanding a basic supply chain, and can usually navigate the hoops needed to ensure they don’t get screwed on a car loan or a warranty on their stereo (although not always, which is why we have consumer advocacy and protection groups). The kind of education needed to understand health care is, to put it mildly, extensive. Regardless of which country you live in, health care systems are often fragmented and convoluted. Even those who work within the system have difficulties navigating it – how could a lay person possibly expect to do better? This question becomes more acutely important when you consider the fact that those laypeople are in crisis while trying to do it.

It is for this reason that we are best served when treatment decisions are made based on the evidence, as interpreted by people who are educated enough to understand it. While it seems unfair that your medical care might be guided by someone you’ve never met, it is far preferable than being pressured into decisions you don’t understand – particularly at a time when you are particularly vulnerable to either manipulation by outside agendas that may not have your best interest in mind, or when you are psychologically less able to make rational, informed choices. While patients must have the right to make the ultimate choice about their care, we are best served as individuals and as a system when the choices available to us are based on the best evidence rather than our own ‘best guesses’.

Well, maybe not if you ask this guy: [Read more...]

Exploring the alternative

I live in Vancouver. Vancouver is home to quite a bit of what is wildly-inaccurately called “alternative medicine”. What people think they mean by this term is medical treatments that fall outside of the conventional combination of surgery, pharmaceuticals, and other forms of medicine that one expects to find in a hospital. Some even fancy these treatments as operating in a different medical paradigm – an entirely new way of looking at the human body and human health.

The truth is that “alternative” medicine has been around forever – it’s how we treated illness before we understood anything about immunology, biology, biochemistry, physics… basically it’s what we did while we were all idiots. Apparently some of us are still wedded to our historical idiocy, and are promoting this prescientific bafflegab under the label of “alternative”. However, there’s nothing alternative about it – it’s just the stuff that doesn’t qualify as real medicine.

People here in North America don’t seem to appreciate this line of reasoning. They accuse people who recognize the importance of basing our health care decisions on scientific evidence of being “closed-minded” and “reductionist”. This is an inaccurate characterization, since the whole principle of the scientific method requires open-mindedness and evaluation of truth based solely on observed phenomena. However, cloaked in a certainty borne of smug arrogance (“science doesn’t know everything – there are other ways to know things”), people readily flock to nonsense ‘treatments’ like reiki, homeopathy, acupuncture, reflexology, and a whole host of others.

However, there are millions of people who turn to these ‘alternative’ therapies because they can’t get actual medicine:

Ignoring the red-and-white danger sign, Sri Mulyati walks slowly to the train tracks outside Indonesia’s bustling capital, lies down and stretches her body across the rails to seek electric therapy. Like the nearly dozen others lined up along the track, the 50-year-old diabetes patient has all but given up on doctors and can’t afford the expensive medicines they prescribe. In her mind, it is only option left. “I’ll keep doing this until I’m completely cured,” said Mulyati, twitching visibly as an oncoming passenger train sends an extra rush of current racing through her body.

Side effects may include headaches, nausea, cramps, and being crushed by a motherfucking train. It is sad to see that a complete lack of a social safety net has resulted in conditions being this bad (are you paying attention Americans? Republican North Party?). It’s stuff like this that lights the fire under me to keep defending a well-run and publicly-funded health care system.

Back to my original point though. I challenge anyone who promotes ‘alternative medicines’ to explain why this particular therapy is stupid, but your treatment of choice isn’t. For those promoting science-based medicine, this task is easy: rigorous examination of patients reveals that those that lie on train tracks to cure their diabetes experience the same rate of cure as those that pursue homeopathy, reiki, crystals, ‘distance healing’, and whatever other nonsense term you’d like to throw out there.

If you’re not of a mind to call this therapy stupid and think that there’s something to it, then I really have to question your sanity. These are people risking their lives for a cure that not only doesn’t work, but can’t possibly work. Diabetes is not a condition of the nervous system. Electrical shocks would have no effect on the ability of the pancreas to produce its own insulin. The only thing that repeated and prolonged shocks might do is the same kind of effect you see in electroconvulsive therapy – massive release of endorphins and neurotransmitters, causing temporary feelings of euphoria. It would certainly explain the types of testimonials available in the article:

But Mulyati insists it provides more relief for her symptoms — high-blood pressure, sleeplessness and high cholesterol — than any doctor has since she was first diagnosed with diabetes 13 years ago.

Illness is a complex and multifaceted concept. I am entirely willing (and so is the medical community) to grant that there is a psychological role to all disease. This doesn’t mean anything quite so Chopra-riffic as being able to think yourself well from cancer, but it does suggest that management of any kind of illness requires an understanding of patient psychology. Anyone who can tap into a patient psychologically can provide “relief” of a certain kind, but that doesn’t do anything to treat the underlying biophysical problem.

Then again, some problems are not exactly biophysical:

The Philippine government has warned against using geckos to treat various diseases, including Aids and cancer, saying the traditional and common practice across southeast Asia could put the ill at greater risk. A Philippine health department statement said on Friday that the use of geckos as treatments had no scientific basis and could be dangerous because patients might not seek proper treatment for their diseases. “This is likely to aggravate their overall health and put them at greater risk,” it said. Treatments for asthma are easily available and affordable, while there are antiviral drugs to control the progress of HIV, the statement added.

Sometimes the problems are more deeply entrenched than even an adequately-funded health care system can address. Proponents of ‘alternative medicine’ often point to the age and popularity of their nonsense as evidence that it must work. After all, the reasoning goes, why would people stick with something that doesn’t make you better? Surely people are inherently rational and will abandon bogus medical intervention once they have been shown not to work. As difficult a time as alt-med types have with evidence, it seems to point in the opposite direction of this hypothesis.

And sure enough, just like in the Phillippines, there are always those who are hovering around the crowd of desperate sick people, circling like vultures and waiting for an opportunity to make a quick buck. The problem is that there will always be hucksters and charlatans who are more interested in making money than making people feel better. Worse, there are those that honestly believe they are helping, but who don’t bother to follow up or investigate their ‘patients’ longer than it takes to pocket their fee and hear a testimonial.

This is a problem that can be addressed only in part by legislation – we can’t really legislate people into rationality. It is for this reason that I am a partisan skeptic: we need to be actively promoting the ideals of basing our decision-making on scientific evidence, rather than simply saying “well people are going to do what they want.” This kind of arch-liberal hands-off cowardice is laying out the path for more abuse, fraud, and ultimately preventable deaths.

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Health care; we still live in the world

So as you may have deduced from yesterday’s marathon post, I am back from my trip. While I spent the first week in sunny and beautiful Amsterdam, I spent the second week in sunnier Toronto – my old home. This trip wasn’t all pleasure though; in fact, I was traveling for business. I don’t talk about this on the blog often, but I work as a health economist. Basically, health economics is a branch of research concerned with resource allocation and decision-making in health care. We look at alternative methods of health care delivery, technologies, programs, etc. and apply the scientific method to work out which options are worth the investment of time, energy, and (ultimately) money. The goal, at least for me, is to maintain the public health system so that it is viable in the long term.

The biggest problem with public provision of health care (or really, any kind of health care provision) is that there are a finite amount of resources available. At every turn, we are confronted by the fact that while costs of care are climbing steadily, the amount of money available to fund treatment can’t even come close to keeping up. At some point, while we’d like to see that everyone gets all the treatment she/he needs and would like, we have to draw a line.

Sometimes we get in our own way a little:

A B.C. woman with a rare, serious skin disease can’t understand why the province refuses to cover a one-time treatment that would likely put it into remission — but will pay for much more expensive treatment that only helps relieve her symptoms…

Dermatologist Gabriele Weichert wrote to PharmaCare, recommending a one-time treatment with Rituximab instead. The drug is approved for treatment of rheumatoid arthritis and other conditions, and Weichert said the drug has also shown much better results in treating pemphigus.

So here it seems there is a clear-cut case where government bureaucracy is getting in the way of medical decision-making. We’ve got a disease, a drug that treats it (at lower cost, no less), and a bloated, inefficient system that won’t cover the cost of the medication because it’s not on “the list”. Pretty shocking, right? Well, until we read this:

A spokesperson for PharmaCare told CBC News approval was denied because Health Canada has yet to approve Rituximab for treatment of pemphigus. Using it to treat that condition is considered “off-label”.

Rituximab is part of a class of drugs called ‘monoclonal antibodies’ that basically mimic the body’s own immune response to foreign proteins. When a strange substance (in immunology, called an “antigen”) enters the body, it is recognized by the white blood cells. They form a chemical impression of the proteins that make up the antigen and begin creating antibodies. Those antibodies coat the foreign protein, signalling other blood cells to envelop and destroy them. Sort of like adding bacon bits to an otherwise-unpalatable salad. Monoclonal antibody drugs do this, but for tumour cells (which are not recognized as ‘foreign’ because they come from the body’s own tissue).

As you might suspect, these drugs are typically used for cancer. Using rituximab for skin disease is indeed an ‘off-label’ usage, and those can be potentially disastrous. The kind of cowboy prescription involved in giving treatments for which efficacy is not established can have potentially fatal consequences, as we’ve seen in the furore around so-called ‘Liberation Therapy’ for multiple sclerosis. The problem here is that there is likely never going to be the kind of trial that we would consider sufficiently strong evidence to justify covering rituximab for use in this setting – the disease is just too rare.

So why not just give it anyway? It’s medicine, right? What possible harm could there be in prescribing it? Well… how about death?

Four people with rheumatoid arthritis have died after being treated with Rituxan, says the drug’s manufacturer, which has issued safety information about the medication in conjunction with Health Canada. None of the deaths caused by a severe infusion-related reaction occurred among Canadian patients, Hoffmann-La Roche Ltd. said in a release.

All drugs have potential adverse effects, and some of those effects might be fatal. Doctors know this, which is why they take such precaution with filling prescriptions (well… that’s debatable I suppose). Giving a medication for an indication that is unknown may result in a miraculous cure, but it might also kill the patient. Because of the vast divide in knowledge between the doctor and the patient, and the unique level of trust that characterizes that relationship, physicians must be extremely careful in the advice they give. When the stakes are high, patients will often leap at opportunities for cures without really understanding all of the variables involved.

This is the tightrope that the health care system must walk every day. If they adhere to the rules and regulations too strictly, they run the risk of undertreating patients, or promoting practices that are inefficient and ineffective. Relax the rules too much and they run the risk of seeing patients die from inappropriate or experimental treatment at the hands of well-intentioned but ultimately misguided care providers. There are horror stories on either side of this divide, which can be (and are) milked in order to shift policy and public opinion.

There is no perfect solution to this set of problems. Different countries employ a variety of different approaches to find a way to maximize patient autonomy whilst simultaneously protecting them from the consequences of their own ignorance. Whenever there are failures, they should be brought up and discussed. The key to any system is one that is not so intractably bound by regulation that it cannot respond to times of crisis (like in the treatment of pehphigus), but not so flexible as to undermine its own ability to safeguard its stakeholders.

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“Liberation Therapy” saga continues

A while back, near the beginning of this blog, I brought to your attention a new potential treatment for Multiple Sclerosis – a severe degenerative disease. The treatment, pioneered by an Italian doctor by the name of Zamboni (I couldn’t make this stuff up – I’m not that creative), is referred to as ‘liberation therapy’, and involves using venous angioplasty (balloons) to clear blockages.

I expressed my skepticism about this procedure at the time, saying that I generally doubted the claim, simply because there’s little connection between the circulatory and nervous systems. It seemed improbable to me, but I was happy (and encouraged others) to wait and see what the evidence says – what happens when we observe patients under controlled circumstances with adequate followup?

Well, it seems that this happens:

People with multiple sclerosis may show blocked neck veins as a result of the disease rather than as a cause, a large study published Wednesday suggests. The findings cast doubt on the theory that blocked or narrowed veins are a main cause of MS, study author Dr. Robert Zivadinov of the University of Buffalo said. The findings published in the journal Neurology were consistent with thinking that the condition — also known as chronic cerebrospinal venous insufficiency, or CCSVI — is more common in patients with multiple sclerosis but not to the degree first reported by Italian doctor Paolo Zamboni.

Please don’t mistake me – I get little pleasure from being right in this case. People close to my family have lived with MS, and I would much rather be wrong if it meant that people could undergo a simple medical procedure and achieve relief from their symptoms. However, the facts are the facts. In this case, the facts do not support the claim that blocked veins contribute to MS, and there is consequently no reason to suspect that alleviating the blockages will have any effect on MS patients.

This study is, perhaps, not the definitive ‘smoking gun’ that liberation therapy is not effective, but it certainly does cast doubt on the original hypothesis of its efficacy. One of the chief components of the scientific method’s accuracy is the ability to reproduce results in a variety of locations. If some event only occurred once, and cannot be observed by others performing the same procedures as elicited the original event, then serious doubt is cast on the original observation. It is far more likely, in a case like this, that there was some flaw in the original observation. This is a good thing – it prevents us from making decisions based on bad information.

However, sometimes we are hell-bent on making those decisions no matter what the evidence says:

The New Brunswick government says it will still help multiple sclerosis patients gain access to therapy to open narrowed neck veins, even though a new report on the procedure is raising concerns. New Brunswick Health Minister Madeleine Dube said that could be debated in the medical community for some time. “But while this is being researched and debated, those people still need support and we are committed to that,” she said Thursday.

There is nothing strictly incorrect about Minister Dube’s statement; however, she and I do seem to have a disagreement over what the word ‘support’ means. Under my definition, it means giving sick people the best care possible, guided by scientific evidence and good practice. Under her definition, it means giving patients whatever they ask for to make them feel better. While I am all for making people feel better, I do not subscribe to the philosophy that cutting people open to elicit the placebo effect constitutes responsible medical care.

For all intents and purposes, there is no reason to suspect that liberation therapy elicits anything stronger than a placebo effect. For every anecdote that states an improvement in symptoms, there is one that talks about how the symptom relief has faded over time. And among those anecdotes, there’s more from people who keep chasing the bad medicine like an addict fiending for a fix:

The monitoring is for Canadians such as Caroline McNeill of Langley, B.C., who travelled to California to have her neck veins reopened using balloon angioplasty. She has had the procedure twice before, and noted lingering benefits such as feeling less tired. “The numbness on my fingers has started to come back again, and I have really bad dizziness and vertigo,” McNeill told her doctor. She plans to return to Newport Beach in Southern California for a stent later this month.

It doesn’t surprise or confound me in the slightest that people who experience a temporary benefit would go back to the well, so to speak, and give the therapy another try. When the current regimen of therapies are only partially effective and carry a whole host of adverse effects, it’s completely reasonable to leap at any alternative. This is why these ‘alternative therapies’ (which is a really stupid name) are so dangerous – they make wild promises that offer benefits that have no scientific backing whatsoever. The people to whom these promises are made are often desperate for any relief, and will try just about anything no matter how dangerous it is.

This is why people who advocate “health freedom” make me so angry – there is no way you can expect people to be dispassionate and conscientious consumers, weighing the plusses and minuses of different options, when the stakes are so high. People’s lives and day-to-day well-being hang in the balance, and they’ll jump at any chance to feel better. This is why our policy should be based on scientific evidence, not the whims of politicians and the desperation of sick people.

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Can we get some of that here?

Romania has the right idea for all the wrong reasons:

Romanian witches and fortune tellers are cursing a new bill that threatens fines or even prison time if their predictions don’t come true. Superstition is a serious matter in the land of Dracula, and officials have turned to witches to help the recession-hit country collect more money and crack down on tax evasion.

I would love to see a law like this passed here, but applied equally to psychics, reflexologists, homeopaths, and any other profession that is in the business of making predictions based on tools that “can’t be measured by science”. Even if they can’t be measured, certainly we can test to see whether they work or not, right? Just like doctors have to keep scrupulous records of the prognosis and outcome of every patient they treat, and are subject to litigation if they make unreasonable predictions and promises, so too should be tarot card readers and other charlatans.

But of course Romania is doing this to separate the “real” witches from the “impostors”. Here’s a hint: they’re all impostors.

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Alternative therapies aren’t ALWAYS full of shit… but this one is

It seems that once again I am donning my ‘scientist’ cap and wading knee-deep into the shit…

Literally:

A hospital physician from a major B.C. facility says several patients died in the last year from C. difficile — unnecessarily — after the health authority stopped her and her colleagues from giving an experimental, simple and highly effective treatment… The treatment, called a fecal transplant, involves introducing stool from a healthy donor — usually a relative — into an infected patient’s bowel, usually through an enema.

Yes, you read that correctly. Dr. Jeanne Keegan-Henry is proposing transplanting somebody’s poo into the bowels of someone with a Clostridium difficile infection in order to cure them.

Poo.

Transplant.

Poo Transplant.

It sounds like the name of a doomed-to-obscurity high school punk rock band. And yet, Dr. Keegan-Henry, who is by all accounts an able and qualified physician, is recommending it. Skeptical smackdown time, right?

Here’s the crazy thing about skepticism. Detractors would characterize it as being resolutely opposed to anything that doesn’t sound like Big Pharma drugs, or is too experimental or outside the realm of conventional medicine. While it is often worthwhile to listen to the criticisms that come from one’s enemies, it is important to resist the temptation to allow them to define your position. More often than not, they are all too happy to succumb to the temptation of straw-manning you into oblivion rather than give a dispassionate description of what it is you actually think (cue the peanut gallery coming out of the woodwork to point out the many times I’ve done it to them).

Skepticism is about evaluating claims, all claims, according to their plausibility and the evidence supporting their truth. When I first caught wind of poo transplants (reader’s note: this article will be stuffed full of poop jokes – you have been warned) my skeptic hackles immediately went up. It’s really the prototypical case – we have a brave maverick doctor who is standing up to the medical establishment and recommending a completely natural remedy to a condition that is usually treated with drugs. For bonus points, it involves enemas. Seems like this ripe stinker was dumped right on our plate as another crazy whackaloon looking for attention (and possibly a book deal).

So, what does a skeptic do? She goes to the evidence! A quick search on PubMed (the U.S. National Library of Medicine National Institutes of Health centralized research database) for “fecal transplant clostridium difficile” reveals 30 hits – not exactly a stellar start; usually it’s in the neighbourhood of a few hundred to a few thousand results. The majority of these hits were commentaries and letters rather than full-blown research articles – also not a good start; what we’re looking for is systematic reviews of clinical trials, or at least trials themselves. We don’t have that – what we have is a handful of case series reports, each representing a tiny number of patients.

So I took a look at the largest case series, that of a 12-patient sample. And the results? Well… would you forgive me if I say “holy shit”?

Click to enlarge

Of 12 patients with infections ranging from 79 to 1532 days (mean length = 352 days), 100% of the patients in this sample experienced a clinical response, defined as “cessation of diarrhea, cramps, and fever within 3 to 5 days”. The authors describe their inclusion and exclusion criteria clearly, as well as the treatment protocol. Patient followup ranged from 3 weeks to many years after the intervention (which is a necessary evil of a case series – it’s not a prospective trial where follow-up can be standardized).

So, cut and dry answer right? Obviously it worked for these patients! No need for further study – let’s approve the shit!

Not so fast…

The reason for putting on the brakes (and possibly leaving skid marks) is that this is one sample of patients. These results are certainly dramatic, but there were no enterobacteriology cultures done – the gut was not examined to see if it was truly the poop that did the trick. The patients from whom the samples were taken had taken doses of antibiotics before donating their sample – was it the poo or the drugs that done it? Even the authors of the paper admit that they don’t have a certain mechanism by which fecal transplantation works. There are certainly some plausible attempts at explanation, but they still don’t know.There was also no control group for comparison (although in a time-series design it is permissible to use the patients as their own controls, comparing them to their pre-trial state – I am channeling that degree in epidemiology!), meaning that we cannot rule out the placebo effect or some other event as explanatory.

Is Dr. Keegan-Henry right? Should we be allowing fecal transplanation? Maybe – the preliminary results are certainly compelling (to go from years of suffering to resolved in 3-5 days is really remarkable). We should be enrolling people in small-scale clinical trials to test for efficacy. Given that there are no observed adverse effects of the transplantation, there’s certainly no reason to block the investigation:

Dr. George Sing, a gastroenterologist at Burnaby Hospital, also wants to provide the treatment to patients. “We did table [a proposal], but it fell into the cracks,” said Sing. “We have been through all the channels … but when it goes through committees it gets bogged down.”

Heh… he said “fell into the cracks”.

This is the hallmark of skepticism – even if something looks totally batshit insane, we test claims against evidence, not against what we think should work. I’ll be interested to see if this story develops.

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This is horrible

I am in favour of a woman’s right to make her own sexual choices. This encapsulates her right to choose her sexual partner, her right to use contraception, and her right to choose whether or not she has a child. I am unmoved by the “logic” of the anti-choicers, which conflates the life of a developing embryo with the life of a fully-grown human person. I am similarly unmoved by their constant appeals to emotion, thrusting pictures of aborted fetuses in the faces of people who already have a difficult decision to make.

I am not, however, unmoved by this:

West Philadelphia abortion doctor Kermit Gosnell routinely delivered live babies in the third trimester of pregnancy, then murdered them by “sticking scissors into the back of the baby’s neck and cutting the spinal cord,” according to the Philadelphia district attorney. One newborn who weighed almost 6 pounds was so big “the doctor joked . . . this baby ‘could walk me to the bus stop.'”

Those are among the jaw-dropping details — complete with photographs — in a 260-page grand jury report released Wednesday that charges Gosnell, 69, with the murder of a patient and seven infants.

The article goes on to detail some of the abject depravity with which this “doctor” treated his victims patients. He hired unqualified people to perform medical procedures, gave inadequate care, and operated under nightmarish conditions:

What they found, according to the report, was “filthy, deplorable, and disgusting”: blood on the floor; the stench of urine; cat feces on the stairs; semiconscious women moaning in the waiting or recovery rooms, covered with bloodstained blankets; broken equipment; blocked or locked exits.

Whatever your feelings on abortion, you can’t help but be disgusted by not only the way in which this man conducted himself, but at the utter lack of humanity at his core. People pursuing medical care are at a fundamental disadvantage – they’re in severe need and are afraid for their safety. This is precisely the reason why all health care practitioners must undergo extensive medical ethics training (I myself have been the recipient of such training at least 7 times over the course of my short career). When someone provides medical care to another, they enter a position of both authority and trust. Those types of relationships are far too easy to abuse – one person is willing to sacrifice a great deal of their autonomy for the chance at relief from suffering. When you’re the person to whom autonomy is being given, you have a moral obligation to work for the best interests of that person, since that person would (under different circumstances) be operating for their own best interest.

Once again I find myself flummoxed by my inability to express sufficiently my utter horror and disgust at anyone who would systematically abuse this kind of trust. Most health care professionals I have had the pleasure of working with take the oaths and ethics of the caregiver-patient dynamic extremely seriously. I know that I do, even though I rarely have any contact with patients in my day-to-day work. To imagine that someone would not only dismiss that ethical responsibility, but outright contravene it in such an egregious and deleterious way for years shocks me. That this happened under the noses of the people who had a responsibility to regulate and inspect it depresses me beyond all belief.

PZ Myers says that this isn’t an argument about the morality of the practice of abortion, and for the most part I agree with him. He hits it squarely on the head when he says this:

Gosnell is precisely the kind of butcher the pro-choice movement opposes. No one endorses bad medicine and unrestricted, unregulated, cowboy surgery like Gosnell practiced — what he represents is the kind of back-alley deadly hackery that the anti-choice movement would have as the only possible recourse, if they had their way. If anything, the Gosnell case is an argument for legal abortion.

Outlawing abortion, as we have seen from international cases like Romania, and even within the United States, does not stop it from happening. All it does is reduce access to safe abortions, allowing monsters like Gosnell to maim more women who have no other options. Criminalizing abortion disproportionately affects the poor, particularly people of colour and immigrants who do not have the same access to resources and illicit medical services that their wealthier counterparts do.

I am deeply aggrieved and horrified that a remorseless killer like Kermit Gosnell exists and was allowed to continue hurting women for so long. I don’t know what the answer to this problem is, but I am confident that putting more women in the tender merciful hands of amoral ghouls like Kermit Gosnell is a step in the wrong direction.

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No refund policy? No, refund policy!

This is the second part of this morning’s story of my homeopathic overdose.

After the “overdose” failed to accomplish anything, I went back to Finlandia and told the person behind the till that I was dissatisfied with the insomnia homeopathic preparation I had purchased, because it didn’t do anything. I told her that it had not changed my sleeping pattern whatsoever, and that as far as I could tell it didn’t work. She went and got the manager, who informed me that there was no refund policy on homeopathy. Peeved, I started to walk out. She stopped me and said that she might be able to do an exchange, although that was against policy too.

The reason for the policy, she told me, was that homeopathy doesn’t work right away. If I was looking for a “quick fix” I should try something else, but that homeopathy supposedly “regulates” my sleeping cycle. I pointed out that it hadn’t done anything like that, even after taking an entire bottle. She suggested that I needed to give it more time and keep going. I said that I was warned about that, and that I wasn’t interested in buying more of a product that didn’t work the first time.

As she ushered me over to the counter of sleeping stuff, she introduced me to the devil herself – the Heel Homeopathy rep. I described my issue to her and she gave me a bunch of the same nonsense about how it was working to ‘balance my energy’ and that I would need to wait for at least a week to see any effect. There was a guy behind the counter who said “it takes time, and homeopathy doesn’t work for everyone” (that old gem). I pointed out that when I came in, I told them I was having a sleeping problem, they gave me something they told me would help – at no point did anyone say “this will help in a week’s time” or “this might not work for you”. I was just told to follow the instructions. There is a difference here between things like antidepressants that actually do take a while to take effect – this information is disclosed to you when they are prescribed. These scam artists had told me no such thing at the point of purchase, and were then trying to evade having to pay me back when their snake oil didn’t work.

The assistant manager quickly swept me away from my debunking, and back to the sleeping pill counter. She then tried to up-sell me a bunch of stuff. The one she pushed the hardest was $44 a bottle! I put on my best skeptical face and said “look, I’m a scientist. I know a thing or two about how the body works, and none of what you’ve said so far addresses my problem.” Sensing defeat, she then buckled and refunded my money in full. Of course, on my way out she tried to sell me a bunch of other stuff, and told me to “do my own research”. Silly manager, I’ve done LOTS of research – you’re full of crap.

I do kind of feel bad about taking the refund under false pretenses, after buying the product under OTHER false pretenses. However, since it was PRESCRIBED under false pretenses, and the people who provide this stuff really ought to know better than to make false health claims, I will sleep just fine tonight (*rimshot*). I will donate the $18 to the James Randi Educational Foundation.

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My homeopathic overdose

If you’re reading this, then I survived a deadly overdose on sleeping pills. It wasn’t my iron constitution, survival instincts or even the quick work of trained medical professionals that saved my life; no, it was the fact that I used homeopathic sleeping pills.

Many of you have probably heard of homeopathy, but don’t really know much about it – this is how they make money. Like Scientology, the explanation is so stupid that once you know about it you can’t believe anyone buys into it. Basically, homeopathy operates on the principle that “like cures like” – for example, an herb that causes fever symptoms is a good cure for fever. The secret is that the substance must be super dilute, and the more diluted it is, the stronger it becomes. Avogadro’s constant (6.02 x 10^23) describes the number of molecules present in a mole of the substance in question – there are, for example 6.02 x 10^23 molecules of O2 in 38 grams of oxygen gas. What this means is that if you dilute something past 23C (C is a number which denotes the number of 100X dilutions a substance has undergone), there is essentially zero chance of even one molecule of active substance being present in the “remedy”.

Many homeopathic drugs are diluted to 30, 100, even 1000C – a sphere of water the size of the entire universe wouldn’t even contain one molecule of the substance. Homeopaths counter this by saying that water has “memory”, and can “remember” what was diluted in it. How it distinguishes between the herbs you want and the thousands of animals that have peed in it, the rocks it has passed over, and the other homeopathic remedies that have been in the same water (more dilute, therefore much stronger) is a question for which an answer has never even been attempted.

For a better explanation of how homeopathy works, go to this website: http://www.howdoeshomeopathywork.com/

It’s no exaggeration to say that homeopathy is completely useless. It couldn’t possibly work without re-writing the entire understanding of chemistry and physics, developed over hundreds of years. Even still, it has been tested – it doesn’t work. While a handful of “studies” (no control group, no proper blinding, small sample size) have shown a small effect for homeopathy – an effect that is much smaller than the claims that are made by homeopaths – every single rigorously-controlled study has shown it to be no different than a placebo. You could give someone a glass of water, tell them it’s homeopathic, and get the exact same result as if you put a drop of onion juice in it then diluted it a billion times.

However, despite the fact that it can’t work, and that it doesn’t work, people still buy into homeopathy in a big way. Walking the streets of Vancouver, it’s easy to stumble across a “natural” pharmacy that sells herbs, vitamins, and of course homeopathic preparations. Homeopathy is a multi-billion dollar industry – essentially the largest legal scam ever perpetrated (aside from, perhaps, religion) – separating desperate people from their money one vial of water or bottle of sugar pills at a time.

What did I do?

On Wednesday, October 27th, I participated in a mass suicide bid along with a handful of other Vancouver skeptics, organized through CFI Vancouver. I went to Finlandia, a naturopathic pharmacy on Broadway, to procure myself some homeopathic sleeping pills. I presented myself to the person behind the counter as a person suffering from insomnia, and curious about homeopathy (which, I would imagine, is a fairly reasonable case study). Without hesitating, the naturopath behind the counter pulled down a bottle of Neurexan, described on the bottle as a “Homeopathic preparation for the treatment of sleeping problems”.

Neurexan - homeopathic sugar pills

You’ll notice that the non-medicinal ingredients are sugar. Nothing else, just sugar. The suggested dose is 3 pills, so consuming the whole bottle would be about 16 doses of sleep meds.

As I would do with any new medication, I asked a few questions:

  1. As a larger person, sometimes I need a higher dosage. Response: It doesn’t matter if you’re 10 lbs or 1000 lbs, use the same dose.
  2. What happens if I miss the directions, or otherwise misuse the product? Response: If you miss a dose, just take a bunch extra.
  3. I’ve used sleeping pills before, and I woke up groggy. Response: Won’t happen with these.
  4. Is it possible to overdose? Response: You can’t overdose on homeopathy because it’s just energy.

If you go to a pharmacy and they tell you that the dose doesn’t matter, that you should just take a bunch extra if you miss the protocol, that there will be no adverse effects at all regardless of your previous medical experience, and that it’s impossible to overdose, make sure you haven’t stumbled into Bizarro world. Such advice from a real pharmacist would be recklessly irresponsible, which is why you get specific instructions when you buy medications.

I honestly don’t think that Jane (not her real name) was out to defraud me. I’m certain she believes that homeopathy works, as do her bosses. However, personal belief is not enough when you have someone coming in with a real medical problem. I might believe that punching you in the uterus will fix your infertility problem, but would you let me? Should you let me? Should you let your sister or wife or mother come to my uterus-punching clinic because she believes it too? No, what you’d likely do is demand some proof from me that it works – proof that you’d examine closely because of how implausible my “treatment” is.

While not the same as an uppercut to the babymaker, the bottle of pills cost me $18 – that’s some expensive sugar! On my way out of the pharmacy, I grabbed myself a copy of this little gem:

Pharma Fiction magazine

You saucy little minx – tell me how it’s the pharmaceutical companies that are defrauding me by selling me stuff that’s been shown to actually work. I’ll believe anything that you and your smoking bottle of pills tells me.

I met up with a group of CFI Vancouver skeptics in front of Vancouver General Hospital. They had all brought their own homeopathic concoctions, including a popular homeopathic flu medication, sleeping pills, arsenic pills and belladonna (the latter two being highly toxic when undiluted). All of these were available from places like Choices and Whole Foods – none of them were particularly cheap. At the appointed hour, we opened our bottles of pills and tossed back the entire thing.

To be clear, if you did this with sleeping pills that you could get as a prescription, or even over-the-counter things like Tylenol, cough medicine, antihistamines, pretty much anything you could get in a real pharmacy, you’d probably die. Even if you didn’t die, you’d be sick as a dog as the pharmaceuticals do what they do inside your body. Even if you didn’t get sick, you’d most assuredly feel something – high, woozy, drowsy, hyper, something. The most likely outcome of downing a whole bottle of sleeping pills is death.

What happened?

Nothing. Nothing happened at all. We stood around for an hour, waiting to feel something. Nothing happened.

What did we learn?

We are not the first group to perform this stunt – a group out of the UK called the 10:23 Campaign first did this on January 23, 2010 as a massive protest against Boots, a naturopathic pharmacy. Since then, the National Health Service (NHS) has called for the stoppage of funding for homeopathy with public money, doctors have petitioned the government to stop licensing homeopaths, and a great deal of light has been shone on this shadiest of practices.

Here in Vancouver, naturopaths are being given diagnostic and prescription privileges. People are flocking to places like Finlandia on the mistaken assumption that the stuff in the bottle does what it says. Homeopaths are banking on a combination of the scientific ignorance of the populace and the veneer of respectibility that accompanies being called a “doctor” to push placebo medicine to desperate people. They compound this by railing against the pharmaceutical companies and the government health regulators, stirring up hostility against the scientific community at large. In fact as a skeptic, it is almost inevitable that you will be accused of being a “Big Pharma Shill” when you bring up the fact that most “alternative medicines” don’t actually do anything (or at least they don’t do what they claim).

The predictable response from those who endorse “alternative” or “natural” medicines is to say “what is the harm? If people think it makes them feel better, why tell them otherwise?” I’ve dealt with this question before, which is to say that the truth is important if we are going to live in a society with other people and make decisions that affect each other. In this particular case though, there is a more tangible cost. This website lists cases of people who died or were seriously injured by belief in quack medicine. Obviously no treatment is perfect, but to convince people to forgo treatment that has a chance of working because you want to sell them something that doesn’t work is tantamount to abetting involuntary suicide.

Another tired trope is that homeopathy only works on some people. It’s quite the coincidence that none of the people who have tried the overdose or who have been observed in carefully designed clinical trials are the ones who it “works” for. The whole point of a study is to control for random differences between people, so that the only difference is the treatment you’re giving them. It would have to be the mother of all coincidences that nobody in these rigorous studies, nobody in our group, and nobody in the 400+ skeptics in the 10:23 campaign felt any effect in the slightest. It would have to be coincidence if it worked – but it doesn’t. The easiest explanation is that homeopathy is just water, with no more “medicine” in it than what comes out of the tap.

We were lucky as well to have the entire thing videotaped by CBC Marketplace as part of their exposé on Boiron, the largest manufacturer of homeopathy in Canada. The episode is due to air this Friday at 8 pm, so you should check it out. I’m not sure if I got on TV or not. Hopefully our merry band of skeptics can help convince people that spending any money on homeopathy is a complete and total waste, because it doesn’t do anything.

Incidentally, I slept pretty much the exact same as I always do that night. I woke up around 3:00 in the morning, rolled over and went back to sleep.

TL/DR: Homeopathy doesn’t work either in theory or in practice. Taking an entire bottle of pills doesn’t have any effect. Homeopaths are defrauding people and giving them sugar pills instead of real medicine.

Make sure you read part two of this saga.

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