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Miss InformationHomeopathy is a form of ‘alternative medicine’ wherein patients are treated with heavily diluted preparations of an ingredient based on the concept that small doses of “what makes a man ill also cures him”. It arose during a time where other long-discarded quackery were in common use – blood letting and purging, for instance. Homeopathic dilutions are such that it would take many gallons of the preparation to ingest even one molecule of the active ingredient. As physicist Robert L. Park noted,

…since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.


Homeopaths believe that such preparations are different from ‘plain’ water, having retained a therapeutically-active memory of the active agent in the final dilution. ‘Succussion’, the stirring or striking at each dilution which increases its potency, is without any justification and seems more in line with being a substitution for the old incantation routine. Since no structure produced by intermolecular forces between water molecules exist for more than a few picoseconds, and succussion would do nothing to stop this (yes, the lack of any stable clusters generated by inner shell hydration of the now long-gone active agent has been verified using NMR spectroscopy1), it would seem that this is just so much bovine excrement. Not to mention that biologically-active molecules do not produce effects through the surrounding hydration shell but through their 3D shape or metabolism directly. Nay – I know not seems!

No homeopathic preparation has ever demonstrated efficacy beyond the placebo effect2. While most homeopathic preparations are harmless (just water usually), they are dangerous because if they are used in place of therapies shown to have efficacy, great harm can indeed result.

Recently, the FDA has issued a warning for Zicam, a cold remedy product touted as being a homeopathic medication, even though it contains significant amounts of homeopathic ingredients and zinc gluconate. Since zinc gluconate might (but probably doesn’t) directly reduce cold symtpoms, it is difficult to understand how Zicam is sold as a homeopathic medicine, but my suspicion is that if the medication actually works Matrixx can then claim that it is the homeopathic ingredients which did the trick. In other words, I think they are trying to hedge their bets by adding along with the homeopathic ingredients something that might (but again, probably doesn’t) work. The levels of zinc it contains can and has caused numerous cases of the loss of the sense of smell. In some cases of zinc toxicity, this impairment of smell can be permanent.  By the way, while zinc gluconate may or may not reduce the duration of cold symptoms (the research is inconclusive on this, but a meta-analysis of studies meeting the criteria of properly-performed trials, and not published in bottom-feeder journals, failed to show any efficacy3), it interferes with the absorption of antibiotics.

In the US, federal legislation stealthily passed excludes homeopathic medical products from requiring FDA approval, effectively removing the demonstration of efficacy or even the demonstration that the product is not harmful. It places the onus of demonstrating harm on the FDA. Matrixx Initiatives, Inc., parent company of the maker of Zicam, has responded that its product causes no harm without providing any evidence that this is the case. Nor are they required to. Ridiculous!!! It will be interesting to see the FDA’s response to this harmful form of quackery. I certainly hope it comes down hard on Matrixx.

Homeopathy is just one of a number of pseudosciences which are a reaction to modern medicine just because it isn’t warm and fuzzy. Modern medicine is ‘too intellectual’ or ‘elitist’, many proponents of these unproven methods will tell you. ‘Too intellectual’? ‘Elitist’? As a member of the medical research community, I’m supposed to be apologetic about knowing my stuff? Not on your life! When my car breaks down, do I take it to a faith healer because I find mechanics ‘elitist’? Using the word ‘elitist’ in the pejorative is like saying you don’t want someone rigorously trained in evidence-based medicine (as a colleague of mine said to me, the term ‘evidence-based’ is superfulous), and ‘degrees’ for homeopathy have little or no oversight. Nor am I aware of any homeopathic ‘degree’ program which includes a residency requirement.

This is how a drug gets into use when following the process required by the FDA. First, it is rigorously tested both in vitro (in the test tube or Petri dish) and in vivo (live animal studies) to show that the drug produces the desired effect. The drug under consideration must show a dose response (that is, the effect is dependent on the dosage) against proper controls (usually the vehicle used without any drug in it), and that it is not toxic at what will be prescribed doses. Once it is shown to be efficacious and safe, it enters into several stages of clinical trials. In this way, the drug is rigorously tested to demonstrate the effects and safety predicted by the pre-clinical trials. It takes years of rigorous testing and monitoring in the four levels of clinical trials before a drug can be approved, and even afterwards deleterious effects are closely monitored using a database of information provided by physicians prescribing it. On average, 1 (count ’em – one!) drug is approved for every 1,000 drugs going through the process!!! And you wonder why drug costs are so high?

Often, a drug is found not by ‘Big Pharma’, but by scientists studying a problem in their field of research. But only ‘Big Pharma’ has the funds to finance its development, especially with such a high failure rate. Why there is such a strong distrust of so-called ‘Big Pharma’ is beyond me. Sure, the system is not perfect. No system is. But it is the best we have and it has evolved and continues to evolve in order to improve itself. But give me one example where the scenario in “The Fugitive” has happened, where histology samples were switched to hide drug-induced liver damage. What would a pharmaceutical company gain when such a fraud would be quickly exposed?

What about drugs that have been recalled due to unpredicted reactions? Do these not demonstrate that the system is broken? NO! It’s a success of the system! The original clinical trials can only be so large and done for so long. If we waited until we had data over whole lifetimes of the subjects in the study before approving drugs, we would still be using only penicillin as an antibiotic. It is the continual vigilance of post-approval monitoring by the FDA that allows us to catch long-term effects of drugs like Vioxx and remove them circulation. Without pharmacovigilance the problems with Vioxx would not have been uncovered until many years after it was discovered to increase the risk of heart attack, if ever. And without pharmacovigilance, there would be far fewer drugs developed by ‘Big Pharma’ found to cause problems to point at and unfairly accuse the system of not working. Ironic, no?

Contrast this with homeopathic medications. Testing? No. Demonstration of efficacy? No. Demonstration of safety? Under the Dietary Supplement Health and Education Act (homeopathic medicines are considered ‘dietary supplements’!!!), but not under FDA guidelines and without need for expiration dates. And believers in homeopathy have a problem with ‘elitist’ methods? Wow, now that’s faith! Matrixx, in their response to the FDA warning about their product, is essentially saying ‘Relax, guy! Trust us!’ without ever responding to the FACT that there are about 130 cases of anosmia (loss of smell) occurring after using Zicam. Isn’t that exactly what those who distrust ‘Big Pharma’ accuse (unfoundedly) ‘Big Pharma’ of doing? Austria has it right – scientific proof of efficacy must be provided for any treatment before the government recognizes it and is paid for by their healthcare system – and France, Austria and Denmark all require that anyone diagnosing illness must be licensed, and guess who they don’t give licenses to. Yet what this industry charges outrageous amounts for their products, essentially ground up dried plants with little or no quality control in terms of how much active ingredient they contain. Compare what you pay for a bottle of ginger tablets at a pharmacy (let alone a specialty store!) with what you pay for the same amount of ginger at the grocery store. If the financial situation of an industry is a source of distrust, why is the ‘natural medicine’ industry, which is in the billions in the US alone, not similarly distrusted? It makes no sense to me.

SmilingBobAs a result of caving in to the will of those who want to see pseudosciences equated with their much more serious evidence-based counterparts,  we can now turn on our televisions and be bombarded with ads shamelessly promoting potentially harmful ‘natural’ (and what, pray tell, makes properly-tested drugs unnatural?) products like Enzyte or Little Allergies Non-Drowsy Allergen Block. Even after legal action we still occasionally see Smiling Bob in commercials advocating Enzyte. Evidence of ‘male enhancement’ – excuse me, ‘natural male enhancement’ – with its use was found to be fabricated by company executives, and owner Steven Warshak was convicted of fraud, conspiracy and money laundering.

For the Little Allergies allergen block,   it is applied outside the nasal passages and this is what the FAQ says about how it works:

Opposite charges attract.  The Little Allergies™ Allergen Block gel carries a charge which is opposite the charge that an airborne allergen carries. Since opposite charges attract, Little Allergies™ Allergen Block acts like a magnet and helps to trap the oppositely charged allergens on contact, much like an air filtration system works.

Okay. I call bullshit here. Since when do allergens carry charges? And if they did, they could be positive or negatively charged, so that would mean that the gel would carry both charges, which would make it electrically neutral. The product contains “petrolatum [read: petroleum jelly], glycerin and other ingredients.” Ever been zapped by Vaseline? Neither have I. If petroleum jelly was charged, it would dissolve in water. And that is NOT how air filtration systems work. First, air filters have, well, a filter, for crying out loud. Second, air purifiers actively electrically charge allergens. And if this is what this stuff does, any child using it would also be breathing in some ozone…

ScreenHunter_02 Jul. 14 10.39It’s possible, I suppose, that the blocking action is achieved by the allergens simply getting stuck to the product as air is breathed in. But since the air is not passing through a filter, but the allergens are expected to magically be attracted to what is essentially Vaseline (at $15 for 1/10th oz.!!!!) as air passes over the gunk with very little air/gunk contact, I don’t expect much in the way of efficacy. But, hey! It uses “no unnecessary additives” and contains no pseudoephedrine (an antihistamine), alcohol, artificial flavors or dyes – or anything that is likely to work, either. Of course, using absolutely nothing will likely provide these same benefits and level of efficacy (or better, using a hepa filter mask).

Parents should not be concerned with giving children antihistamines for relieving symptoms of rhinitis, particularly the second-generation H1-antihistamines4. Some members of this antihistamine class, such as cetirizine, desloratadine and fexofenadine are approved for children as young as 6 mo. While I do not like over-prescribing medications, I must say (speaking as a sufferer of rhinitis) I am also no fan of refusing medication at the expense of my quality of life.  Parents should be aware that the second generation of antihistamines are extremely safe. Their use to effectively relieve symptoms in their allergy-suffering children should not be overlooked (and let’s face it,  it is suffering) just because someone claims to have an all-natural, yet unproven, remedy or a product that magically removes allergens from the air as they breathe by means of a mechanism that is highly suspect.

There seems to be some irrational association between something that is ‘natural’ and ‘efficacious and unharmful’. Foxglove (digitalis) is natural, useful in treating heart disease and deadly in anything but very small doses. A guy I know was surprised to find out that sugar and honey are calorically even though somehow honey is ‘natural’ and sugar is not(?). And the herbal medicine industry is not without its own Vioxx situations. Remember ephedra? It’s as natural as the heart failures it produced. There is also this strange belief that the ‘old wisdom’ of using herbs and other methods supported only by anecdotal evidence is somehow better than what modern medicine provides. Why not go whole-hog and return to animal sacrifice as part of health care? The level of evidence is the same.

I once bought some skin cream at a department store because I liked it. It wasn’t greasy and it was readily absorbed by my skin. I didn’t buy it because I bought into the sales pitch that “it’s made from olive leaves, the only type of leaf that regenerates!” Yeah, I’ll remember that when next I’m reincarnated as an olive tree. I find it rather implausible that the olive leaf extract will impart regenerative properties on my aging face just because the plant itself. If I accept this, by the same logic I must also accept that it will turn my skin green and I will start photosynthesizing. Exercise those critical thinking skills!

cetirizine,
desloratadine, and, most recently, fexofenadine

Because of political pressure from those who are satisfied with completely non-rigorous standards of evidence when it comes to treating their health problems (and think that this is a plus), I can walk into a pharmacy and buy all manner of unproven bric-a-brac, like herbs (conspicuously devoid of any mention of what they are used for) or copper and magnetic bracelets. As I believe it is professionally unethical to provide therapies which have not scientifically demonstrated efficacy, I call on Canadian pharmacies to do what they did with the selling of cigarettes – fully extricate themselves from the practice of selling unproven herbal and homeopathic ‘medicines’ which are ineffectual or potentially harmful.

I’m going to end this entry with a thought experiment – one which you can readily carry out, too – showing why homeopathy is nonsense that is so clear anyone can understand it, even its biggest believers. Ethanol is a drug. No two ways about it. Aside from life-long teetotalers, all of us of drinking age (legal or not) know it produces measurable effects we can readily experience by acting on GABAA receptors and changing the hydrodynamic properties of the fluid in the inner ear we use to maintain balance. It is also used to treat methanol poisoning, as it competitively inhibits the action of alcohol dehydrogenase on methanol to form formate (the toxic product which destroys the optic nerve) until the methanol is out of the system. Let’s say I’m totally soused. Not true at the moment, but just for argument’s sake. The principle behind homeopathy is that a little (or, using typical homopathic dilutions, none) will actually cure me of my inebriated state.

Now, if we believe the homeopaths, after ingesting most of a bottle of Cruzan (my favorite rum, distilled in the US Virgin Islands), I can make the effects go away. Now before believers start jumping on me that I am trying to cure myself of something that I have ingested, look at Zicam. One of the homeopathic ingredients is histamine dihydrochloride. According to homeopathic theory, a small amount of histamine will cure one of the histamine response. In other words, Zicam contains histamine to diminish the histamine response producing cold systems just as I am analogously using a small amount of alcohol to sober myself up. The problem agent does not care if it is ingested or generated in situ via an immune response. So, we create the homeopathic preparation by progressively diluting a shot of rum till on average not a molecule is left, shaking at each dilution. Which outcome do you predict after administering the preparation? You find-

  1. sobriety and reality have disappointingly returned; or
  2. that no matter how much succussion the concoction tastes exactly like water and you’re still completely soused.

Or don’t you trust me?

References

  1. Anick DJ, “High sensitivity 1H-NMR spectroscopy of homeopathic remedies made in water”, BMC Complement Altern Med 4: 15 (2004).
  2. Ernst E, “A systematic review of systematic reviews of homeopathy”, Br J Clin Pharmacol 54 (6): 577–582 (2002).
  3. Caruso TJ, Prober CG, Gwaltney JM. “Treatment of naturally acquired common colds with zinc: a structured review”, Clin. Infect. Dis. 45 (5): 569–74 (2007).
  4. Schad CA, Skoner DP. “Antihistamines in the pediatric population: Achieving optimal outcomes when treating seasonal allergic rhinitis and chronic urticaria”, Allergy Asthma Proc. 29:7-13 (2008).
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5 Comments

  1. I am an ex-homeopath (certified in a whole 180 hour course ! smile).

    Some points:
    1) Much of orthodox medicine practiced at the founding of Homeopathy was barbaric and much more painful to the patient than the homeopathic remedies , thus they did not have a relatively better improvement rate due to a lower kill rate. Likewise, Mohammed’s Islam offered a relatively better world than the tribalism it replaced.

    2) I think people ought to be allowed to poison themselves with anything of their choice, thus I want Homeopathic meds legal. BUT, I am against false advertising.

    3)

    Why there is such a strong distrust of so-called ‘Big Pharma’ is beyond me.

    Are you serious? I am a Physician Assistant. Pharm reps have one mission, to persuade — and truth takes a far second seat. They start by deceiving themselves. You are far too trusting, it seems.

    I lectured for years against the trial-tested, science-backed cough medicines for kids, well, we see where they go now. I don’t trust antihistamines as blanketly as you do. Diet, exercise, environment improvement and other methods can work well before medicines. We need not run to drugs for everything — Western, Homeopathic, Ayur Vedic, Herbal or others.

    But your rank against Homeopathy and its deceptions are well taken !

    • I agree with part of point 1. That medicine in the past was not only barbaric, but actually contributed to death is quite apparent. Just ask George Washington’s bled-out ghost. No argument. But that’s in the past, and homeopathy show no efficacy whatsoever. But we have replaced anecdotal-based medicine with evidence-based medicine, and for damn good reasons. Consider something like echinacea. Anecdotally, it’s said to stimulate the immune system, but there’s not one shred of evidence that it does, and repeatedly. However, I find that the blanket claim that “Islam offered a relatively better world than the tribalism it replaced” perplexing. First, how is Islam, Christianity, Judaism, Jainism, etc. not tribalistic? Second, what is it about Islam that was better than the religions it replaced? It seems to me that improvements to society have more to do with advancements in technology, like moving from hunter-gatherer to agrarian societies or application of the germ theory of disease.

      While I agree with the sentiment of point 2 (I’m largely libertarian and believe in taking responsibility for one’s rather than suing anything that moves like we do today), you have not taken into account the ethics that a health care provider must abide by. Should a pharmacist provide something which does not demonstrate efficacy, or is even harmful? I think this would make a pharmacist ethically culpable in any harm. One could argue that the pharmaceuticals which do show efficacy can be abused. True. But that is why it is also a pharmacist’s and physician’s responsibility to explain what the medications do and how to administer it. If someone abuses a drug, then we’re back to personal responsibility. Even if a product does not do specific harm in that it is useless, providing it is still unethical in the same way that unnecessary surgery is unethical. If I were a pharmacist, I would tell people that if they want to poison themselves or use useless remedies they can find it elsewhere. I would refuse to be an enabler and give the ‘remedy’ any tacit credibility by providing it just to make a buck. In the same way, many Canadian pharmacies removed cigarettes from their shelves voluntarily long before it was mandated by law.

      For point 3, you have hit on a point that I did not consider, and it isn’t just pharmaceutical representatives taking physicians out for dinners or trips. I find television advertising by the pharmaceutical industry to be unethical as well. This is a very active discussion in the medical community, and some Canadian universities ban the practice of pharmaceutical representatives from access to medical students (if they haven’t all done so). But I disagree that this should translate to the distrusting of the drugs themselves. After all, no matter what the advertising practice of a drug company, all pharmaceuticals go through the same rigorous procedure. For any condition, there may be many different drugs used for treatment. I’ll take the example of depression, usually treated with SSRIs. There are quite a few SSRIs out there – Paxil, Zoloft, etc. A good thing, too. Conditioning tends to result in a decrease in the efficacy of any one SSRI. Since there are so many out there, drug companies advertise and advocate their version. However, regardless of one’s level of trust, no drug company is allowed to lie about their product or imply something about it which is not true. Contrast this with what the herbal remedy industry (and it is just as much an industry as the pharmaceutical industry, but without anywhere near the oversight). Occasionally, one gets caught in and out-and-out lie (Enzyte), but the stuff that the herbal remedy industry is allowed to get away with must piss off the pharmaceutical industry immensely. Indeed, if we take every herbal remedy that is anecdotally said to provide therapeutic value and subject each to a double-blinded properly-controlled study, damn few would pass muster. We’ve seen a few, like echinacea and glucosamine, discarded as useless already. Some are just plain harmful. These reasons alone tell me that any distrust of ‘Big Pharma’ should be dwarfed by a very reasonable distrust of alternative medicine industries.

      I have to ask what it was about cough medicines for kids that you based your objections on. If you knew something from epidemiology or similar sources that was indicating a problem with them, that’s one thing. If it’s just the idea that giving cough medicines to kids is bad, that’s another. The latter has the same logic behind it as the anti-vaccination crowd’s. We can only act in accordance with the best available information. It is simply not reasonable (or even ethical, in my opinion) to not act (i.e., not administer a drug) because of a personal philosophy or belief that children should not be given pharmaceuticals. As a sufferer of rhinitis myself, I can tell you that for airborne allergens, diet, exercise, etc. are useless. I’d always been affected by airborne allergens, but when I was doing my PhD I used rats in my studies and became deathly allergic to them. As soon as I entered the lab, I would sneeze uncontrollably to a disco beat. I’m not kidding. (Weirdly, my allergy to rats is gone.) But if I were a kid with serious rhinitis I’d be pleading for antihistamines rather than be forced to spend my life living in a bubble next to an air purifier. At this point, there is no epidemiological information which would suggest that it is harmful to prescribe second-generation antihistamines to children.

      For mild rhinitis in children (or adults, for that matter), I agree. Why prescribe? So they sniff a lot. I have a slight headache, so why run to the medicine cabinet for ibuprofen when it will go away in a short while? But to not prescribe for children with severe rhinitis because the physician thinks that there might be unspecified problems despite there being no indication of such by any research is silly and harmful. Sure, something may show in epidemiological studies some day. Mia culpa. But if that happens, is it then logical to say in hindsight “I told you so, so it shouldn’t have been done”? I don’t think so. That is advocating inaction out of irrational fear of consequences that, because of rigorous testing, are very unlikely to occur. We should act in accordance with the best available information, after considering the ethical issues. I’m not saying that since no study so far has shown significant problems with second-generation antihistamines aside from the usual drowsiness (which is far and away better than the alternative, I assure you) that in future the same will hold. Pharmacovigilance is very important and I don’t advocate blind trust in drugs. I’m saying irrational fears have no place in the decision-making process.

      And there’s a second problem with prescribing diet, exercise, etc. Since this falls under lifestyle change, I think it is unethical to prescribe it. Suggest, it yes. Even strongly suggest. But not prescribe. (This is not an absolute – physical rehabilitation should be prescribed, but I’m not talking about exercise in this sense.) Take this example. What if being religious were to be found to be beneficial to health? Should a doctor then prescribe that the patient become religious if an atheist, or increase church attendance if they are already religious? Screw that. That’s out of bounds regardless of any potential benefit. (And this IS happening, sadly. If you want to read a very scary book, try Richard Sloan’s Blind Faith.) I don’t see a difference between the prescribing exercise and religion. Now, if exercise were the only therapeutic strategy, you might have a case.

      Man, that was long.

  2. 1. Am I wrong to assume you don’t know much about Islam? The Tribalism I spoke of was the tribes in that part of the Saudi peninsula that Mohammed was fighting and trying to unite. The role of women, believe it or not, was worse before Islam. Problem is that Islam froze. Religion evolves and Mohammed was one phase that has fossilized.

    3. OK, you can dwarf you concerns with “Big Pharma”, but remember, even a dwarf can nail you in the nuts.
    I forgot you are not a medical practitioner — the ineffectiveness of cough medicines is all over the literature from the last 5 years or more. I will let you do the searching. Yet these drugs have been sold as safe and effective. They aren’t. The epidemiological studies about (I have an MPH from Hopkins, btw, so I am up on the level of evidence issues etc).
    Concerning rhinitis — I have been pushing “Neti Pots” for decades. Normal medical providers have put me down on this for 20 years. Now ENT offices are using them. I will let you look it up.

    I think irrational fears have a place in decision processes when consequences can be very bad or benefits are minimal. For reason is often blind and intuitions (which are laden with faults) can sometimes benefit us in those moments. But I understand your point.

    Wow, I love your strong position against prescribe lifestyle change.
    Here is an example of what I want.

    Anti-cholinergics have lots of side-effects, one being is stops urination. So we use it with people you have spastic bladders. The only work to a small degree and at best you get a 50% improvement. But, if an obese person (those who most commonly get this sort of disorder) loses 20 pounds, they get the same improvement.

    If Obama makes the government the insurer of health care in the USA, I don’t want to pay for Anti-cholinergics for other people who choose to be fat. Sure, some can’t help it, but they are a minority. Same with HTN, type II DM etc. That is the problem with government paying for health. Why should I be forced to pay for someone’s bad habits but I can’t prescribe for them. We can avoid it all with health care accounts where everyone can pay for their own care. Then we have catastrophic stuff for illnesses and injuries unrelated to lifestyle. But as you know, that will never happen.

    • I admit I am more familiar with the Judeo-Christian religions. I think you have oversimplified things, however. My comment that Islam and other religions are tribalistic stands. Instead of being based on kin, the Abrahamic religions base tribal membership on belief. All these religions have done is change the membership requirements. They’re still tribal. But I understand that you are talking about unification of disparate groups. However, I don’t think that I could ever possibly advocate the means by which Mohammedans achieved this. Remember, the Shah of Iran was very progressive on women’s issues, too. I’m not sure that Islam didn’t actually take steps backwards. Early in its history the Islamic nations were a beacon of knowledge and later it actively repressed knowledge. Christianity tried to do the same thing, but failed. Now Christians claim that it produced science, when it was through Christian individuals who were dissatisfied with the answers their religion was giving them. Science arose despite Christianity.

      As to the use of neti pots, I can’t see any evidence that they should replace topical steroids or antihistamines, but probably should be used as an adjunct. A quick look at the literature tells me that more properly-controlled studies need to be done. Quite a few studies don’t have proper controls. That goes for most medical research, actually. Honestly, anyone doing medical research should be required to take a course in experimental design and relevant statistical methods. It drives me nuts.

      I think irrational fears have a place in decision processes when consequences can be very bad or benefits are minimal. For reason is often blind and intuitions (which are laden with faults) can sometimes benefit us in those moments. But I understand your point.

      Absolutely not. We act on the best available information, and while it is natural that irrational fear raises its ugly head, it should be smacked down with a sledgehammer. You can only act on what you know, not what you don’t know (aside from too little knowledge, where the appropriate action is to gain the necessary information). Otherwise, we run the risk of fear-induced paralysis. Risk assessment can only be performed using what you know. If a drug doesn’t provides only a small benefit, there isn’t much point in prescribing it. And if you have no information pointing to bad consequences, how do you know that there could be bad consequences? There can always be bad consequences, but if you can’t identify them and it is just an irrational fear, is it justifiable to not prescribe based on that? I don’t think so at all. As I’ve said, when the information is there, you can only act on what you know.

      As for the doctor-patient relationship, I have very strong opinions on its limitations. There are just some things that are out-of-bounds. Telling someone how to live their life is one of them. Besides, I doubt compliance would be achieved.

      And here’s where I simply can’t agree with you. You acknowledge that some people are unable to control weight. They are a very small minority, but you advocate saying “Well, that’s too bad, but we’re going to lump you in with the recalcitrant ones”? That’s pretty harsh. Or those that suffer from emphysema, even though they haven’t had a single cigarette in their lives? Do we tell these people “Too bad”? Where do we draw the line and who should make that call? Besides, aren’t you guys south of the border (excepting Alaska, of course) already paying for your own health care through insurance premiums?

      Instead of excluding people from health care systems, why not get government to take the lead in promoting lifestyle habits which lead to good health? Tax the hell out of fast foods like we do cigarettes here in Canada, make membership in gyms and leisure centers and their use a taxable benefit, make eating healthy cheaper, things like that? The cost of vegetables versus a burger and fries from Wendy’s is ridiculous. Not that I’m going to put away my barbecues (yes, plural) any time soon. But it seems to me that we should learn from how society changed its outlook on the smoking habit. I think it would be vastly more effective to make society view unhealthy lifestyles as unacceptable. It’s a slow change, but there is no quick fix.

  3. Good one. When I first heard of homeopathy I was taken in by the lie of water memory. Now I understand that it’s clearly nonsense, but it’s hard to argue against the strong placebo effect.

    http://wammers.wordpress.com/2009/12/03/trebly-impossible/


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