Dec 17 2009
“Intrepid, Ragged Band of Bloggers” take on CAM
“When someone comes in with a vague sense of unease, or a touch of the nerves, or even just more money than sense, you’ll be there for them – bottle of basically just water in one hand, and a huge invoice in the other.”
David Colquhoun published an excellent editorial this week in the British Medical Journal (BMJ) in which he looks back at the last 100 years of “secret remedies.” He points out that a century ago the medical establishment and government regulators tried to protect the public from unscientific patent remedies, but those efforts were anemic, and eventually faded away. Now we are in the midst of a resurgence of unscientific remedies, and those who should be protecting the public health are not even mounting a half-hearted defense.
David refers to an “intrepid, ragged band of bloggers” along with a few journalists who are the only ones pointing out the folly of abandoning the science-based standard of care in medicine. He writes:
One hundred years on from the abortive efforts to crack down on patent remedies, we need to look again at the efficacy of remedies. Indeed the effort is well under way, but this time it takes a different form. The initiative has come largely from an “intrepid, ragged band of bloggers” and several journalists, helped by scientific societies. It hasn’t been helped by the silence of the BMA, the royal colleges, the Department of Health, and a few vice chancellors.. Even the National Institute for Health and Clinical Excellence (NICE) and the Medicines and Healthcare Products Regulatory Agency (MRHA) could be helping more.
The response of the royal colleges to the resurgence in magic medicine that started in the 1970s looks to me like embarrassment. They avoided the hard questions by setting up committees (often populated with known sympathisers) so as to avoid having to say “baloney.” The Department of Health, equally embarrassed, refers the hard questions to the Prince of Wales’ Foundation for Integrated Health. It was asked to draft “national occupational standards” for make believe subjects like “naturopathy”).
David is writing from a British perspective, of course. I could say the same, however, about the American Medical Association (AMA) and American medical schools. State and federal governments have been terrible – allowing a few zealots and vested interests to slowly erode the standard of care and protections for the public in favor of quack-friendly laws. Senators Harkin and Hatch have diverted medical research funds to chase unicorns (via NCCAM). They have also pushed through laws that cripple FDA regulation of certain health products, like supplements, and create massive loop-holes for the supplement industry to exploit the public.
He also points out the folly of recognizing, through licensure, health professions that are ultimately based on nonsense.
But you cannot start to think about a sensible form of regulation unless you first decide whether or not the thing you are trying to regulate is nonsense.
Unless a practice or profession is based upon transparent evidence, how can meaningful regulation take place? If proponents can simply make up their own standards based upon ideology and philosophy, without being held to any external standard, the regulation is a farce.
But there is a glimmer of hope that we may be finally getting through to some elements of the public and the government that science-based regulation is necessary, and the diversions and deceptions of the so-called alternative medicine industry may have begun to crumble. Talking about a recent committee’s review of the evidence for homeopathy, David writes:
The committee’s proceedings are worth watching, if only to see the admirably honest admission by the professional standards director of Boots that they sell homoeopathic pills without knowing whether they work.12 But for pure comedy gold, there is nothing to beat the final session. The health minister Michael O’Brien was eventually cajoled into admitting that there was no good evidence that homoeopathy worked but defended the idea that the taxpayer should pay for it anyway.
Boots is a large British pharmacy chain. The video is worth watching – finally a regulator asking the important questions – does homeopathy work? The answer, as David points out, is “no” but we don’t care, we want to sell it anyway, and taxpayers should pay for it too.
Of course, the lame defenses came also.
Then at the end of the session Harper said, “homeopathic practitioners would argue that the way randomised clinical trials are set up, they do not lend themselves necessarily to the evaluation and demonstration of efficacy of homeopathic remedies.”
Right – homeopaths are experts at the kettle defense. They claim there is evidence that homeopathy works, when there isn’t. When someone is paying attention enough to push them on the details, the least delusional of them must admit there is no evidence, so they retreat to the argument that it is because science is rigged against them. As David then points out, this excuse for lack of evidence is especially lame when it comes to homeopathy – which is typically given as pills. Pill-based treatments are the easiest to control and blind with placebos.
David concludes:
“Imagine going to an NHS hospital for treatment and being sent away with nothing but a bottle of water and some vague promises,” wrote the Sun’s health journalist Jane Symons recently. “And no, it’s not a fruitcake fantasy. This is homeopathy and the NHS currently spends around £10m on it.” It isn’t often that a Murdoch tabloid produces a better account of a medical problem than anything the Department of Health’s chief scientific advisor can muster.
It is a sad state of affairs when not only tabloids, but comedians, are doing a much better job of informing the public about the reality of homeopathy and other fantasy-based treatment than governments, medical organizations, and universities.
Mitchell and Webb capture the essence of homeopathic practice, and alternative medicine in general, better than the BMA, the AMA, and any government official I have ever heard.
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12 Responses to ““Intrepid, Ragged Band of Bloggers” take on CAM”
Dr. Novella,
Many of us do appreciate the work that you and others are doing (huge fan of SGTU btw). I am frequently linking your blog in my fb account with critical thinking excerpts, my little way to spread some logic. thanks.
When is it not ok to allow people to do what they want with their own money? Why should people be allowed to buy Fiji water but not homeopathic remedies? A lot of purchases by a lot of people aren’t rational. They are made because they make the buyer feel better in some way. e.g. New cars, gambling, clothes that are only worn once, Apple Macs, gym memberships never used, cigarettes, political donations, etc. Even many advertised over the counter medicines may not be a rational purchase for everyone who buys them.
I can see that the use of taxpayers’ money is one area where there needs to be a clear rule but apart from that, it isn’t obvious to me what you are suggesting should happen.
The worst examples of misleading advertising should be curbed but the advertisers will always find a way around the rules. I see obviously unhealthy snacks advertised “for healthy appetites”, which is a blatant way to get the word “heathy” on the label. Products say “no added sugar” but are full of artificial sweeteners or “no artificial sweeteners” when they are full of sugar.
The underlying problem with regulation is that you are trying to regulate something you believe is completely ineffective as a remedy. How do you propose to distinguish those things from everything else, which is also ineffective as a remedy?
juga:
Your comparison of homeopathic remedies with other consumer goods and services makes sense, provided you are perfectly happy with buying:
* New cars that fail to get out of your driveway.
* Gambling with a rigged game.
* New clothes that disintegrate in the washing machine.
* Computers that consistently eat your documents.
* Memberships at gyms with no equipment.
* Cigarettes that cause cancer. (Uniquely factual.)
* Political donations that are used to pay for hookers.
But hey, let the buyer beware, right?
Because it is unethical and often fraudulent. Because people don’t always know, the placebo effect is not medicine. Becuase it gives people the false impression that because it is sold it must work as advertised. Because then when people demand it (even when it doesn’t work) it then ends up being used by doctors because they can or because its profitable. Thus leading to minor but important amounts of corruption.
Because it is time consuming and irritating to find proper medicines among all the natural cr*p. I should not have to play the lottery on medicine. Neither should I have to wade through pointless choice, especially when 1/3rd of the choices don’t ACTUALLY work.
It is not rocket science to only be able to sell stuff which works. We have other standards already in place, we also have testing of other medicines.
As far as I am concerned, the standards in England have been corrupted deliberately and this should be punished at all levels.
You sell untested medicines, you should be punished. You sell water as medicine, you should be punished. You corrupt the standards for profit at the expense of peoples health, you should be punished.
@juga
The argument you are making there makes sense but it’s not the point. Effectively you are saying
“why pick on homeopathy when there is other bad stuff out there?”
And then you list a range of things that fit the bill, and mention that people buy bad stuff.
The difference in my opinion with Hpy is that it has pseudo official sanction. Insurance companies, governments and corporate entities endorse it, in many cases knowing there is no evidence that it works.
So I agree people should be able to waste their own money on it. But it shouldn’t be funded by your insurance or your taxes, and it shouldn’t be sold alongside real medicine.
In the UK we are campaigning to get it off the shelves at Boots. Do we want it taken off the market completely? No. I don’t think so. But there are “natural shops” and places where this stuff could be sold without the apparent endorsement of trusted high street pharmacy brands.
The question of customer choice is only valid when there is equality in the customer’s understanding of hpy and real medicine. Separating the retail of these products helps with that understanding.
I can see from your opening statement that you agree hpy is pseudo science. Let’s send it back to the medieval corner it came from.
Andy
Fiji water is not touted as a cure-all, a patent medicine. It is a product whose sales are being decreased because of criticism launched at its supposed ‘green’ angle. The criticism is working.
Fiji water is not a part of an alternative medical regime like homeopathy is. If labeling was on all alternative medicine that no effectiveness has been proven, then I doubt that sales would remain robust. If shoppers still want to buy products that are clearly marked ineffective, you really have to wonder about their mental state, but yes, they would have the right to spend their money on worthless stuff as long as they were not breaking any laws.
I understand the libertarian position – but even the most libertarian of my colleagues agree that lying in advertising about health products is not acceptable and should be regulated.
I don’t give any credence to those who take a “let the buyer beware” approach to health care. This is nonsensical in my opinion. I liken this to saying that consumers can decide for themselves if their cars are safe, or if a bridge is safe to drive over.
In some industries a minimal standard of safety and transparency is worth the restrictions needed to enforce the standard.
Once we agree there should be some standard, then we can dicker about whether or not companies should be free to sell health products as long as their claims are true, or if there should be a requirement for safety and substantiating claims before even getting to the market.
Do you think drug companies should be free to sell whatever drugs they want without any burden of proof of safety or effectiveness? If not, then you agree in principle with my position, and we are just discussing where and how to draw the line.
Basically – with regard to health products I am OK with a range of regulations for different types of products – as long as the public is protected from fraud or harmful products.
In my opinion, since homeopathy is 100% worthless, I cannot imagine any marketing of a homeopathic product that is not fraud.
Also – I think it is harmful for governments to endorse worthless products or quackery. Health care professions should be held to a science-based standard. To license nonsense is to betray the public trust.
Finally – our society can no longer afford an anything goes approach to health care. We need cost-effective health care at every level. I therefore think we can make a reasonable social argument that worthless remedies and practices are unethical because we simply cannot afford them as a society.
Cost-effectiveness requires science to determine what works and what doesn’t work.
An appropriate blog topic for me today–I’m doing a little last-minute reviewing for a law school exam in food and drug law.
Juga, there really are ways to protect consumers without stepping all over their rights as buyers. You can outlaw fraudulent claims, misleading claims, adulterated products, mislabeling, or products made in insanitary conditions; you can also require testing for safety and efficacy. The necessary laws are already on the books (with the exception of some totally F***ED exceptions for “dietary supplements” and “medical Devices”), and if the FDA wanted to, they could do industry-wide crackdowns. They won’t, because they can be sued for wrongful seizure and the like, while they can’t be sued for non-enforcement. So the result is a neutered administration that just pretends like all the quackery doesn’t exist.
To Michelle and Steve-
A lot of “alternative” medicines fall under the dietary supplement definition, which does not require pre-market approval of claims like drugs do. There is an explicit exception that keeps vitamins, minerals, herbs, and botanicals out from under the drug umbrella–they are effectively unregulated. Most carry the required disclaimer “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” So we all see how well disclosure works…
I must point out that the rather fine expression “intrepid, ragged band of bloggers” is not mine, but was taken from an article written by Ben Goldacre earlier this year in the Guardian. He was referring to the speed with which bloggers analysed the “plethora of evidence” produced by chiroquacktors in order to back their defamation action against Simon Singh. If you haven’t done so already please sign up to the new campaign to reform the UK’s dreadful libel laws, at http://libelreform.org/sign.
I agree with your thesis that the acquiescence of the AMA is very much like that of the BMA. In fact arguably the problem is even worse in the USA. In the UK, the penetration of magic medicine into universities has been restricted to a few universities that are not, how shall I put it, not at the top of the intellectual hit parade (but which nevertheless do excellent work in many areas). Even they are now shutting down these courses now. In the USA, crackpot medicine has been eagerly embraced by Harvard, Yale, Stanford and just about every other university that can extract a bit of cash from NCCAM or Bravewell.
Perhaps this is the movment to plug again the movie Integrative baloney @ Yale. It had quite a good reception when I showed it during a seminar at Yale. Most of the audience seemed to be have quite unaware what was going on. Let’s make them aware.
This is a common defense of unproven medical claims — people should have choice. I think people should be allowed to buy whatever remedies they want. However, there do need to be consequences for misrepresenting the product you’re selling. Nobody’s proposing making it criminal to buy homeopathic remedies. They’re proposing making it illegal to sell them as medicine. (You could still sell them as water, of course. You just couldn’t claim stuff that isn’t true about them.)
The reason this is important is precisely because people make non-rational choices. They buy expensive crap they don’t need because marketers are very good at manipulating them. When it’s a question of buying, say, an Audi instead of a much cheaper Kia, that’s not really a big deal. But when it’s a question of buying homeopathic antimalaria pills instead of chloroquinine and travelling to subsaharan Africa, it IS a big deal. People could die because of the false claims being made, because it delays them seeking real treatments. So the stakes are too high to go all “caveat emptor” on this. Besides, we have tried that approach before. It did not work out well.
Meanwhile, they’ve wasted money on something that doesn’t do what they’ve been told it does. It’s fraudulent to sell an empty box claiming that there’s a TV set inside. Why isn’t it fraudulent to sell pure water claiming that there’s a drug inside?
juga on 17 Dec 2009 at 11:24 am “When is it not ok to allow people to do what they want with their own money?”
The real question concerns spending public money on quackery. I don’t care how you spend your money; but I do care where my taxes go.